Understanding defensive medical practices among physicians in Turkey: a latent class and structural equation modeling approach

With advances in law and patient rights, defensive medicine has become a widespread phenomenon in clinical practice. This study aimed to determine the frequency of defensive medical practices among physicians working in Tokat, Türkiye, and to identify the factors associated with these practices. This descriptive, cross-sectional study was conducted between July 1 and November 1, 2022. After physicians not involved in direct patient care were excluded, 322 physicians (91.7% participation rate) completed a questionnaire comprising 48 questions developed by the researchers, together with the validated 18-item Defensive Medicine Practices Attitude Scale. Data were analyzed using descriptive statistics, the chi-square test, the Kruskal–Wallis H test, partial least squares structural equation modeling, and latent class analysis. Of the participating physicians, 59% ( n = 190) were male, the mean age was 35.07 ± 8.37 years, and 59.3% were employed at a university hospital. Overall, 93.8% of physicians reported engaging in defensive medical practices. Latent class analysis identified three classes comprising 163, 89, and 70 physicians, in which defensive medicine was reported by 98.8%, 87.6%, and 90.0%, respectively. The key factors associated with defensive medical practices included age, clinical experience, perceived adequacy of medical education, professional fears, and the perceived likelihood of facing a malpractice lawsuit. Addressing defensive medical practices requires a comprehensive approach combining reforms in medical education, supportive legal and institutional frameworks, and robust psychosocial support for physicians. Class-specific patterns suggest that interventions tailored to distinct physician profiles may be more effective than uniform strategies.