Gynybinė medicina Lietuvos sveikatos apsaugoje: gydytojų gynybinių reakcijų formavimasis
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Defensive medicine is a flawed health care phenomenon, when the main doctor’s priority becomes the striving to protect himself against possible legal prosecution for possible errors in diagnosis and treatment. The article analyses sources of doctors’ defensive responses in a given clinical situation. The article continues the presentation of the results of 2440 Lithuanian doctors’ study (2011–2012). The previous article introduced its general results, whereas the current one discusses differences of defensive reactions in different medical specialties and further differences that are caused by individual characteristics of a physician, patient and a clinical situation. Examining differences in defensive reactions in different specialties, it was found that a high level of defensive reactions were inherent in all medical specialties investigated. Therefore, in Lithuanian health care, there do not exist any ‘safe’ specialties, which do not use defensive medicine to protect themselves from prosecution actions. The study also identifies the most sensitive (insecure) medical specialties (general practice physicians, internal medicine specialists, pediatricians, neurologists). An important result of the study was large differences (variance) of defense reactions within each specialty. It turned out that even within a single specialty physicians may react very differently depending on the features of an individual doctor, patient and a clinical situation. In order to clarify the interaction between these characteristics, factor analysis (principal component method with Oblimin rotation) has been carried out. This analysis made it possible to discover two fundamental factors responsible for the interaction between different traits of a doctor, patient and a clinical situation and play the crucial role in the development of defensive reactions of doctors. The outcomes of the study showed a highly important role of grass-root psychological, ethical and cultural relations between doctor and patient in both arising and depressing of defensive medicine. The study showed that some doctors were quite successful in solving patient’s confidence problems and this way is ‘immune’ from factors and effects causing defense medicine. A doctor who is able to understand patient’s feelings (also his distrust) has incomparably better conditions to overcome this distrust. On the contrary, a doctor who sees patient’s distrust as an expression of his hostility has no other option than to defend and to use defensive medicine methods. This provided the basis for the concept of the ‘double-aetiology’ of defense medicine with legal and social factors acting on the societal level and quite different psychological ones prevailing on the interpersonal doctor-patient level.
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