title: Clinical guidelines, defensive medicine, and the physician between the two.
abstract: OBJECTIVE
  In this article, we study the use of the American Academy of Otolaryngology-Head and Neck Surgery recommendations regarding coagulation screening tests before tonsillectomy and adenoidectomy by ear, nose, and throat (ENT) physicians in Israel and offer insights into the reasons for accepting/declining this recommendation.
  
  
  METHODS
  During April and May 2002, 309 self-administered questionnaires were sent to all ENT physician members of the Israeli Society of Otolaryngology-Head and Neck Surgery. Physicians answered questions regarding demographic data, their habits of preoperative laboratory and imaging tests before tonsillectomy and adenoidectomy, and the reasons for performing these tests.
  
  
  RESULTS
  One hundred ninety-six (63.4% compliance rate) physicians responded to the survey. One hundred fifty-four (78.6% of the responding physicians) do not follow guideline recommendations and ask their otherwise healthy patients to undergo prothrombin time/partial thromboplastin time (PT/PTT) tests before tonsillectomy and adenoidectomy. Common practice in their departments was the leading reasoning for preoperative PT/PTT testing for 101 (51.5%) physicians. Eighty-nine physicians (45.4%) specifically stated that the reason for this behavior is defensive medicine, thirty-two physicians (16.3%) stated that the reason for those tests is hospital requirements, and literature recommendation was the reason in 24 (12.2%), followed by personal experience for 11 physicians (5.6%).
  
  
  CONCLUSIONS
  Most ENT physicians in Israel do not follow clinical guidelines and perform unnecessary coagulation tests before tonsillectomy and adenoidectomy. More studies are needed to find ways to change physicians' behavior regarding preoperative tests.
authors.affiliation: Department of Health Systems, Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. atoker@bgumail.bgu.ac.il
authors.forename: Asaf
authors.initials: A
authors.lastname: Toker
authors.forename: Shifra
authors.initials: S
authors.lastname: Shvarts
authors.forename: Zvi H
authors.initials: ZH
authors.lastname: Perry
authors.forename: Yariv
authors.initials: Y
authors.lastname: Doron
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
mesh_terms: D000233:Adenoidectomy; D001780:Blood Coagulation Tests / Q000379:methods / Q000706:statistics & numerical data*; D003657:Decision Making; D003675:Defensive Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy