Consequences of Defensive Medicine, Second Victims, and Clinical-judicial Syndrome on Surgeons' Medical Practice and on Health Service

Overview

Journal Updates Surg

Specialty General Surgery

Date 2015 Dec 10

PMID 26650202

Citations 25

Authors

Italia Maria Pellino

Gianluca Pellino

Affiliations

Soon will be listed here.

Abstract

Increased knowledge in disease causes and progression, along with technological and technical advancements in their diagnosis and treatment, have led to increased expectations from physicians by patients and their relatives. The condition of "second victim" is known to affect caregivers that commit an error, and seriously impairs private life and subsequent practice. Besides, a condition has been described, the clinical-judicial syndrome, affecting caregivers at any moment during a medical litigation. In this scenario, physicians have started to practice "defensive medicine", aimed at protect themselves from liability rather than actually advancing care of patients. This paper represents the first review on defensive medicine with specific focus on surgery in an Italian setting. We reviewed the literature on the topic, with particular focus on surgeons and Italian current status, and provide the readers with a snapshot on these relevant issues, proposing strategies to prevent and reduce the practice of defensive medicine, and to support patients and physicians suffering from medical errors.

Citing Articles

Understanding the Second Victim Phenomenon Among Healthcare Workers in an Italian Hospital.

Sedile R, Zizza A, Bastiani L, Carluccio E, Marrazzi M, Bellandi T Eur J Investig Health Psychol Educ. 2024; 14(12):3073-3086.

PMID: 39727509 PMC: 11675350. DOI: 10.3390/ejihpe14120201.

Policy Options for Reducing Defensive Medicine Behaviors: A Multi-Method Study.

Zarei E, Yousefi I, Shiranirad S, Poursaki T, Zahmatkesh M, Farrokhi P Med J Islam Repub Iran. 2024; 38:86.

PMID: 39678762 PMC: 11644114. DOI: 10.47176/mjiri.38.86.

Understanding veterinary practitioners' responses to adverse events using a combined grounded theory and netnographic natural language processing approach.

Gibson J, Oxtoby C, Brennan M, White K PLoS One. 2024; 19(12):e0314081.

PMID: 39636830 PMC: 11620440. DOI: 10.1371/journal.pone.0314081.

The European Researchers' Network Working on Second Victim (ERNST) Policy Statement on the Second Victim Phenomenon for Increasing Patient Safety.

Mira J, Carillo I, Tella S, Vanhaecht K, Panella M, Seys D Public Health Rev. 2024; 45:1607175.

PMID: 39360222 PMC: 11445080. DOI: 10.3389/phrs.2024.1607175.

The influence of fears of perceived legal consequences on general practitioners' practice in relation to defensive medicine - a cross-sectional survey in Germany.

Goetz K, Oldenburg D, Strobel C, Steinhauser J BMC Prim Care. 2024; 25(1):23.

PMID: 38216861 PMC: 10785451. DOI: 10.1186/s12875-024-02267-x.

References

Canonico S, Pellino G, Pameggiani D, Sciaudone G, Candilio G, De Fatico G . Thyroid surgery in the elderly: a comparative experience of 400 patients from an Italian university hospital. Int Surg. 2014; 99(5):523-7. PMC: 4253918. DOI: 10.9738/INTSURG-D-14-00030.1. View

Panella M, Rinaldi C, Vanhaecht K, Donnarumma C, Tozzi Q, DI Stanislao F . [Second victims of medical errors: a systematic review of the literature]. Ig Sanita Pubbl. 2014; 70(1):9-28. View

Pellino G, Sciaudone G, Candilio G, Camerlingo A, Marcellinaro R, Rocco F . Complications and functional outcomes of restorative proctocolectomy for ulcerative colitis in the elderly. BMC Surg. 2013; 13 Suppl 2:S9. PMC: 3851043. DOI: 10.1186/1471-2482-13-S2-S9. View

Pellino G, Sciaudone G, Selvaggi F, Canonico S . Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action. Updates Surg. 2015; 67(3):235-45. DOI: 10.1007/s13304-015-0298-z. View

Studdert D, Mello M, Sage W, DesRoches C, Peugh J, Zapert K . Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005; 293(21):2609-17. DOI: 10.1001/jama.293.21.2609. View

Seys D, Wu A, Van Gerven E, Vleugels A, Euwema M, Panella M . Health care professionals as second victims after adverse events: a systematic review. Eval Health Prof. 2012; 36(2):135-62. DOI: 10.1177/0163278712458918. View

Moynihan R, Smith R . Too much medicine?. BMJ. 2002; 324(7342):859-60. PMC: 1122814. DOI: 10.1136/bmj.324.7342.859. View

Selvaggi F, Fucini C, Pellino G, Sciaudone G, Maretto I, Mondi I . Outcome and prognostic factors of local recurrent rectal cancer: a pooled analysis of 150 patients. Tech Coloproctol. 2014; 19(3):135-44. DOI: 10.1007/s10151-014-1241-x. View

Melotti G, De Antoni E, Habr-Gama A, Minicozzi A . Management of distal rectal cancer: results from a national survey. Updates Surg. 2013; 65(1):43-52. DOI: 10.1007/s13304-012-0192-x. View

10.

Pellino G, Selvaggi F, Ghezzi G, Corona D, Riegler G, Delaini G . A think tank of the Italian society of colorectal surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: Crohn's disease. Tech Coloproctol. 2015; 19(10):639-51. DOI: 10.1007/s10151-015-1368-4. View

11.

Mavroforou A, Malizos K, Karachalios T, Chatzitheofilou K, Giannoukas A . Punitive limb amputation. Clin Orthop Relat Res. 2014; 472(10):3102-6. PMC: 4160514. DOI: 10.1007/s11999-014-3480-6. View

12.

Shaw D, Elger B . Evidence-based persuasion: an ethical imperative. JAMA. 2013; 309(16):1689-90. DOI: 10.1001/jama.2013.2179. View

13.

Pellino G, Sciaudone G, Candilio G, Selvaggi F . Effect of Surgery on Health-Related Quality of Life of Patients With Locally Recurrent Rectal Cancer. Dis Colon Rectum. 2015; 58(8):753-61. DOI: 10.1097/DCR.0000000000000403. View

14.

Cacciola N, Calabrese C, Malapelle U, Pellino G, De Stefano A, Sepe R . UbcH10 expression can predict prognosis and sensitivity to the antineoplastic treatment for colorectal cancer patients. Mol Carcinog. 2015; 55(5):793-807. DOI: 10.1002/mc.22322. View

15.

Selvaggi F, Pellino G, Sciaudone G, Candilio G, Canonico S . Development and validation of a practical score to predict pain after excisional hemorrhoidectomy. Int J Colorectal Dis. 2014; 29(11):1401-10. DOI: 10.1007/s00384-014-1999-3. View

16.

Amato A, Pellino G, Secondo P, Selvaggi F . Intersphincteric approach for rectourethral fistulas following radical prostatectomy. Tech Coloproctol. 2015; 19(11):699-703. DOI: 10.1007/s10151-015-1346-x. View

17.

Wu A . Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000; 320(7237):726-7. PMC: 1117748. DOI: 10.1136/bmj.320.7237.726. View

18.

Gallagher T, Waterman A, Ebers A, Fraser V, Levinson W . Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA. 2003; 289(8):1001-7. DOI: 10.1001/jama.289.8.1001. View

19.

Pellino G, Petronella P, Selvaggi F . Gradual staple line disruption presenting with subtle multidiverticular pocket syndrome after STARR. Updates Surg. 2014; 66(4):291-2. DOI: 10.1007/s13304-014-0274-z. View

20.

Waterman A, Garbutt J, Hazel E, Dunagan W, Levinson W, Fraser V . The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007; 33(8):467-76. DOI: 10.1016/s1553-7250(07)33050-x. View