Factors associated with defensive medicine practice in United Arab Emirates: A cross-sectional study with multivariate analysis

Health services institutes worldwide are trying to reduce defensive medical practice to limit its negative impact on patient care. We evaluated the factors associated with this defensive medical practice among medical professionals in the United Arab Emirates. This study deployed multivariate logistic regression analysis. Defensive medical practice was defined according to the responses given to questions about potentially unnecessary referral, testing, and additional care in a cross-sectional 23-item questionnaire administered to medical professionals after obtaining ethical committee approval. The factors evaluated were: age, gender, medical specialty, job grade, years of practice, country of medical graduation, country of specialty board, current practice in hospital or private sector, feeling supported by workplace staff, being involved in litigation, and indemnity cover. Multivariate models determined the adjusted odds ratios (aOR) and 95% confidence intervals (CI) after taking account of confounding; aOR > 1 indicated a positive association of factors with defensive practice while aOR < 1 indicated a negative association. There were 562 respondents. The most common defensive medical practice related to referring on a case after sensing the possibility of a complaint (365, 64.9%); the factors associated were senior grades (aOR 0.74, 95% CI 0.56–0.98, P = .04), private sector (aOR 1.27, 95% CI 1.008–1.61, P = .04), and indemnity cover (aOR 0.49, 95% CI 0.26–0.93, P = .03). The second most common defensive practice was calling inpatient admission, delaying discharge, additional testing, etc without medical indication and solely on patient or family request (265, 47.1%); the factors associated were age (aOR 0.46, 95% CI 0.33–0.64, P = .001), private sector (aOR 0.66, 95% CI 0.53–0.83, P = .001), and support by workplace staff (aOR 0.50, 95% CI 0.34–0.73, P = .001). Other defensive practices included refraining from difficult procedures or referring cases to another colleague due to the fear of complications (166, 29.5%) and unwillingness to accept patients in case of previous litigation history (157, 28.1%). This multivariable analysis in the United Arab Emirates found that higher age, higher job grades, indemnity cover and support by workplace staff reduced the odds of defensive medicine practice while working in the private sector had a mixed effect.