High legal risk perception despite high medicolegal awareness: a cross-sectional survey of haematologists in Türkiye

Objectives To evaluate medicolegal awareness, exposure to legal processes, perceived legal risk, institutional support and defensive medicine behaviours among haematologists in Türkiye, and to identify factors associated with defensive medicine practices. Design A cross-sectional, web-based survey study. Selection criteria Haematologists actively practising in Türkiye were invited to participate in a voluntary, anonymous online survey. Outcome measures A 26-item questionnaire assessed medicolegal awareness, exposure to legal processes, legal risk perception, institutional support and defensive medicine behaviours. Composite scores were calculated for medicolegal awareness (0–100), medicolegal exposure (0–10) and defensive medicine (4–20). Correlation and multivariable linear regression analyses were performed to identify factors associated with defensive medicine behaviours. Results A total of 200 haematologists participated. More than half (57%) reported patient concerns and 32% reported involvement in civil litigation or expert witness processes. The mean Medicolegal Exposure Index was 2.07/10. The mean Legal Awareness Score was 83.3% (95% CI 80.6% to 85.9%), although knowledge gaps were identified regarding the purpose of informed consent (60% correct) and responsibility in multidisciplinary decision-making (61% correct). Nearly all respondents (97%) agreed or strongly agreed that they frequently felt their clinical practice carried legal risk, whereas only 17% agreed that their institution would support them if they faced legal problems and only 8% reported easy access to reliable medicolegal information. Legal concerns influenced clinical decision-making in 58% of participants. Self-reported defensive medicine behaviours were common (mean score 10.24/20), particularly extensive documentation (92%), increased follow-up or hospitalisation (64%), excessive consultation (47%) and referral of high-risk patients (36%). In the primary adjusted model, higher medicolegal exposure, lower perceived institutional support and female sex were independently associated with higher Defensive Medicine Scores, whereas participants aged 40–49 years had lower scores than those aged 30–39 years. In a sensitivity analysis, adding the item assessing whether legal concerns influenced clinical decision-making substantially increased model fit, but this item was not retained in the primary model because of conceptual overlap with the defensive medicine outcome. Conclusion Haematologists in Türkiye reported frequent exposure to medicolegal processes and high perceived legal risk despite relatively high awareness levels. Exploratory adjusted analyses suggested modest associations of defensive medicine behaviours with medicolegal exposure and perceived institutional support, although the latter was not statistically significant when years of practice replaced age. Medicolegal awareness was not independently associated with the outcome.