From concept to experience: surgical and perioperative physicians perceptions of medical error and defensive medicine using the vignette technique

This study investigates surgical and perioperative physicians perceptions of medical errors and defensive medicine, with a particular focus on how these perceptions are shaped by conceptual understanding, clinical experience, and systemic factors. Given the high-risk and time-constrained nature of surgical practice, surgical and perioperative physicians represent a critical cohort for examining the impact of the fear of medical error on clinical decision-making. A qualitative phenomenological design was employed. The study was conducted with 23 surgical and perioperative physicians practicing in public and university hospitals in Türkiye, selected via purposive criterion sampling. Data were collected through semi-structured interviews supplemented by vignettes designed to simulate ethically and clinically challenging surgical scenarios. Prior to the vignette discussions, participants were asked to define key concepts namely medical error, medical negligence, complication, fear of medical error, and defensive medicine. Subsequently, standardized definitions were provided to ensure conceptual alignment. Data were analyzed using Braun and Clarke’s thematic analysis approach. The findings suggest that surgical and perioperative physicians experienced conceptual ambiguity regarding medical error, malpractice, and complication. Their accounts also indicated that fear of legal repercussions and professional scrutiny may contribute to defensive clinical behaviors alongside organizational culture, workload pressures, and the medico-legal environment. The findings suggest that surgical and perioperative physicians perceived clinical decision-making as being influenced not only by clinical considerations but also by medico-legal concerns and system-related conditions, which may encourage defensive practices. By focusing explicitly on surgical and perioperative physicians, this research contributes to the literature on patient safety, surgical ethics, and defensive medicine by offering an in-depth, clinician-centered perspective grounded in real-world surgical contexts.