Prevalence of defensive medicine behaviors, associated risk factors and its mitigation strategies among physicians in Gaza Strip, palestine: a mixed method study

Defensive Medicine (DM) is defined as all medical services that physicians provide without real benefit to patients, and the real reasons are to protect themselves from legal issues. Little is known about this issue in the Gaza Strip, from the perspective of physicians. This study aims to assess the prevalence of DM behaviors, associated risk factors, and the mitigation strategies among physicians in the Gaza Strip, Palestine. This study utilized an explanatory sequential mixed methods design including both quantitative and qualitative designs from April 2023 to July 2023 in eight governmental hospitals in the Gaza Strip. In the first phase, quantitative data was collected using a self-reported questionnaire through a cross-sectional survey among 200 physicians who were recruited using a simple random sampling method. In the second stage, qualitative data were gathered using a semi-structured interview with ten key informants who were selected via a purposive sampling method to identify mitigation strategies for DM prevalence. Quantitative data were analyzed using descriptive statistics via SPSS-22. The content analysis method was used to analyze interview data. The prevalence of DM-related behaviors ranged from 30.5% to 75.5%. The highest rate of DM performed behaviors were unnecessary consultations (75.5%), issuing excessive medical instructions (65.5%), referring patients to the emergency room (63.5%), unnecessary imaging (61.5%), and unnecessary laboratory investigations (60.5%). Risk factors in the logistic regression analysis for DM-related behaviors were; gender, work department, qualification, previous lawsuits, type of working shift, and work hours (p < 0.05). The main strategies to prevent or reduce DM are Designed continuous training and teaching programs, the relationship between doctor and patient, reforming the liability and complaints system, Health system reform. The study displayed the proportion of physicians who frequently performed DM-related behaviors and the socio-demographic variables of the physicians that positively affect the frequently performing of the DM-related behaviors. In addition, the study identified four categories of possible solutions to reduce the practice of DM which include designing continuous training and teaching programs, enhancing the trust relationship between physician and patient, reforming the liability and complaints system, and health system reform.