Defensive medicine practices among gastroenterologists in Japan

Table 1 Characteristics of gastroenterologists surveyed (n = 131)

Characteristic	Gastroenterologistsn (%)
Sex
Male	110 (84)
Female	21 (16)
Years in practice
1-10	33 (25)
11-19	67 (51)
20-29	26 (20)
30	5 (4)
Practice type
Solo	18 (14)
Hospital clinic	107 (81)
Other	6 (5)
Perceived burden of liability insurance premiums
Not a burden	14 (11)
Minor	17 (13)
Medium	57 (43)
Major	3 (33)
Claims experience
Sued
≤ 3 yr ago	1 (1)
> 3 yr ago	2 (1)
Never sued	128 (98)

Table 2 Frequency of assurance and avoidance behaviors among gastroenterologists surveyed

	Oftenn (%)	Never/rarelyn (%)
Assurance behavior
Order more tests than medically indicated	7 (5)	83 (64)
Prescribe more medications (e.g., antibiotics) than medically indicated	0 (0)	110 (84)
Refer patients to other specialists unnecessarily	36 (27)	41 (32)
Suggest invasive procedures (e.g., biopsy) to confirm diagnosis	21 (16)	61 (47)
Avoidance behavior
Avoid certain procedures or interventions	24 (18)	32 (24)
Avoid caring for high-risk patients	27 (21)	32 (24)

Table 3 Relation between assurance and avoidance behaviors and years in practice

	Number ofyearsin practice	Often/sometimesn (%)
Assurance behavior
Order more tests than	1-9	14/33 (42)
medically indicated	10-19	26/67 (39)
	20-	8/31 (26)
Prescribe more medications	1-9	7/33 (21)a
(e.g., antibiotics) than	10-19	13/67 (19)c
medically indicated	20-	1/31 (3)
Refer patients to other	1-9	24/33 (73)
specialists unnecessarily	10-19	47/67 (70)
	20-	19/31 (61)
Suggest invasive procedures	1-9	21/33 (64)
(e.g., biopsy) to	10-19	36/67 (54)
confirm diagnosis	20-	13/31 (42)
Avoidance behavior
Avoid certain procedures	1-9	28/33 (85)
or interventions	10-19	52/67 (78)
	20-	19/31 (61)e
Avoid caring for high-risk patients	1-9	28/33 (85)
	10-19	52/67 (78)
	20-	19/31 (61)e

^aP = 0.033,

^cP = 0.027 vs 20 yr in practice;

^eP = 0.032 vs 1-9 yr in practice.

Table 4 Relation between assurance and avoidance behaviors and practice types

	Practicetype	Often/sometimesn (%)
Assurance behavior
Order more tests than medically	Solo	2/18(11)a
indicated	Hospital clinic	43/107 (40)
	Other	3/6 (50)
Prescribe more medications	Solo	1/18 (6)
(e.g., antibiotics) than	Hospital clinic	19/107 (18)
medically indicated	Other	1/6 (17)
Refer patients to other specialists	Solo	18/18(100)b
unnecessarily	Hospital clinic	69/107 (64)
	Other	3/6 (50)
Suggest invasive procedures	Solo	10/18 (56)
(e.g., biopsy) to	Hospital clinic	57/107 (53)
confirm diagnosis	Other	3/6 (50)
Avoidance behavior
Avoid certain procedures	Solo	12/18 (67)
or interventions	Hospital clinic	82/107 (77)
	Other	5/6 (83)
Avoid caring for high-risk patients	Solo	14/18 (78)
	Hospital clinic	80/107 (75)
	Other	5/6 (83)

^aP = 0.013,

^bP = 0.0006 vs hospital clinic.

Table 5 Specific defensive medicine practices among gastroenterologists (n = 118)

Most recent act ofdefensive medicine	Gastroenterologistsn (%)
Recorded interaction with patient	41 (35)
in considerable detail
Referred patient to another physician	39 (33)
Avoided certain procedure or intervention	25 (21)
Ordered more tests than medically indicated	13 (11)