Objectives This study investigated whether the attitudes
of physicians towards justified and unjustified litigation,
and their perception of patient pressure in demanding
care, influence their use of defensive medical behaviours.
Design Cross-sectional survey using exploratory factor
analysis was conducted to determine litigation attitude and
perceived patient pressure factors. Regression analyses
were used to regress these factors on to the ordering of
extra tests or procedures (defensive assurance behaviour)
or the avoidance of high-risk patients or procedures
(defensive avoidance behaviour).
Setting Data were collected from eight Dutch hospitals.
Participants Respondents were 160 physicians and 54
residents (response rate 25%) of
