Defensive practice among psychiatrists in middle East Countries: A questionnaire survey

Purpose: Increasing medicolegal litigations, claims and compensation have forced doctors to make some defensive changes in their practice. This study was conducted to examine the prevalence of defensive practice among psychiatrists in Middle Eastern countries along with examining the relationship of defensiveness with seniority and previous medicolegal experiences. Methods: A questionnaire with thirteen questions was shared among 215 psychiatrists practicing in Middle Eastern countries. The collected data were analysed statistically using SPSS version 21. Results: Ninety-two valid responses were received and analysed, out of which sixty-two of them were from Saudi Arabia. An overall 30% (n = 28/92) of the psychiatrists have taken a defensive action in their practice in the past one month. Nearly 28% (n = 26/92) of them approved unwanted patient admission, 30% (n = 28/92) kept the patient on a higher observation. Both these defensive actions are less prevalent among the senior psychiatrists. While 24% (n = 22/92) and 30% (n = 28/92) of psychiatrists had written specific remarks such as “not suicidal” and dictated letters more than necessary for managing patient's illness, respectively, and this behaviour was more prevalent among senior psychiatrists. Conclusion: An overall 30% (n = 28/92) of the psychiatrists have taken a defensive action in their practice over the past one month. Knowledge and experience of previous medicolegal issues were important factors influencing the defensive practice. The propensity of junior psychiatrists to practice defensively may be attributed to decreased confidence. More systematic problem-based training, proper guidelines for practice insurance and more clarity and transparency in the investigation and handling of medicolegal issues may help reduce the defensive practice and improve better patient care.