Defensive medicine practices and attitudes toward malpractice among physicians in Jordan: a cross-sectional study

BACKGROUND: Defensive medicine (DM) refers to clinical practices motivated primarily by perceived medicolegal risk rather than patient benefit. In Jordan, evidence remains limited regarding physicians' defensive practices, awareness of defensive medicine as a formal concept, understanding of the 2018 Medical Liability Law, and attitudes toward malpractice litigation. METHODS: A cross-sectional survey was conducted among a convenience sample of 211 physicians in Jordan between August 2023 and March 2024. A structured questionnaire assessed DM practices (10-item scale), attitudes toward malpractice litigation (5-item scale), familiarity with defensive medicine, self-rated understanding of the 2018 Medical Liability Law, litigation exposure, insurance status, and perceived patient pressure. Multivariable linear regression analyses were performed to examine factors associated with defensive medicine and attitude scores. RESULTS: Defensive medicine was reported by 84.4% of physicians, with a low-to-moderate overall intensity (mean item score across the 10 DM items : 2.1 ± 0.54 on the original 1-5 scale). Assurance behaviors predominated, particularly additional diagnostic testing perceived as precautionary or unnecessary (59.3%). Only 30.8% were familiar with the term "defensive medicine", and 60.7% rated their understanding of the 2018 Medical Liability Law as poor. In the multivariable analysis, younger age (B = -0.34, p = 0.024), prior malpractice litigation experience (B = 4.89, p < 0.001), and perceiving litigation as a personal attack (B = -1.18, p = 0.012) were independently associated with higher defensive medicine scores (R² = 0.178). Specialty risk category was not independently associated with defensive medicine after adjustment. In the attitude model, familiarity with defensive medicine (B = 0.82, p = 0.028) and lower defensive medicine scores (B = -0.06, p = 0.047) were associated with higher attitude scores toward malpractice litigation (R² = 0.132). CONCLUSION: Defensive medicine was common among physicians in this sample and was expressed mainly through assurance-type behaviors. The findings suggest that defensive practices may be more closely associated with perceived professional vulnerability, prior litigation experience, and threat-related perceptions than with specialty risk category or self-rated legal understanding alone. Given the cross-sectional design and convenience sampling, these findings should be interpreted as exploratory and require confirmation in larger, more representative studies.