Evaluation of family physicians' attitudes to defensive medicine practices and its effect on providing driving licence reports

Objective: To examine the attitude of family physicians practicing at primary care units in İstanbul regarding defensive medicine practices and their effect on providing driving license health report provisions and the frequency of dispatches. Methods: 396 family physicians practicing in primary care units in Istanbul were included in this observational and descriptive study between March and April 2023. Volunteering physicians were invited to participate in an online questionnaire including sociodemographic characteristics, knowledge and experience questions about defensive medical practice (DMP), the number of examinations and driving license provisions they have issued in the last year, and the rate of referrals to secondary or tertiary health centers. Defensive Medicine Practices Attitude Scale (DMPAS) was also performed online through which negative and positive DMP attitudes were assessed. Participants were classified as having very high (55-44 points), high (43-33 points), moderate (32-22 points), and mild (21-11 points) defensive attitude. Participants' attitudes towards providing driving license health reports were scored with a 5-point Likert-type scale. DMPAS scores were compared in terms of all data. Results: Among 396 participants, more than half were female (54.3%; n=215). Mean age was 39.3±8.9 years [Min 24,0-Max 60.0]. According to DMPAS, 94.5% of the participants exhibited a moderate or higher defensive attitude. Participants who were male (p < 0.05), married (p < 0.05), and specialist physicians (p < 0.05) scored significantly higher in DMPAS compared to their counterparts. As the physicians’ age, years of experience, and the number of registered patients increased, DMPAS decreased (r = -0.668, p < 0.001; r = -0.638, p < 0.00; r = -0.154, p = 0.002, respectively). The study shows that physicians who frequently refer patients to secondary or tertiary hospitals for driving reports and who have a high demand for driving reports among those aged 17 and over in their care population exhibited significantly higher defensiveness scores (p < 0.05). In other words, physicians who had more defensive attitudes preferred to consult the provision to the secondary or tertiary hospitals rather than approving the application. Conclusion: Defensive medicine practices in family physicians are relatively high, increasing the dispatch rate in driving license reports. The increasing rate of referrals from primary care units due to defensive medicine practice results in a patient burden on secondary or tertiary healthcare institutions.