Medical Malpractice Stress Syndrome, Malpractice-Related Anxiety, and Defensive Medicine Practices Among Emergency Medicine Physicians in Türkiye: A National Cross-Sectional Survey

Background/Objectives: Medical Malpractice Stress Syndrome (MMSS) describes the psychological and behavioral consequences of malpractice-related concerns and may contribute to defensive medicine practices. Emergency medicine physicians are particularly vulnerable to medicolegal risk because of the high-acuity and time-sensitive nature of their work. This study aimed to evaluate MMSS awareness, malpractice-related stress, and defensive medicine practices among emergency medicine specialists in Türkiye. Methods: A national cross-sectional web-based survey was conducted among emergency medicine specialists practicing in Türkiye between 1 April and 1 June 2026 and was distributed through professional emergency medicine networks and congress-related channels; because the survey was disseminated through multiple open professional platforms, an exact response rate could not be determined. The questionnaire assessed demographic characteristics, MMSS awareness, malpractice-related experiences and anxiety, and defensive medicine behaviors. Defensive medicine practices were evaluated using the validated Turkish version of the Defensive Medicine Attitude Scale. Associations between malpractice-related anxiety and defensive medicine behaviors were analyzed using Spearman correlation analysis. Results: A total of 128 emergency medicine specialists completed the survey. Malpractice-related anxiety was highly prevalent and frequently influenced professional attitudes and clinical decision-making. Defensive medicine practices were common, with assurance-type behaviors being substantially more frequent than avoidance-type behaviors. Malpractice-related anxiety demonstrated a significant positive correlation with assurance defensive medicine behaviors (r = 0.383, p < 0.001) but not with avoidance behaviors (r = 0.139, p = 0.118). Assurance and avoidance defensive medicine scores were positively correlated (r = 0.575, p < 0.001). Conclusions: MMSS and malpractice-related anxiety are highly prevalent among emergency medicine physicians in Türkiye and are associated with widespread defensive medicine practices. Malpractice-related anxiety appears to primarily promote assurance-type defensive medicine behaviors rather than avoidance behaviors. These findings suggest that medicolegal stress may influence clinical decision-making and contribute to increased healthcare utilization in emergency medicine.