title: Health transformation project and defensive medicine practice among neurosurgeons in Turkey.
abstract: BACKGROUND
  The term "Defensive" medicine was coined in the early 1970's and has been an important topic of scientific investigation and professional debate ever since.
  
  
  OBJECTIVE
  The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey.
  
  
  METHODS
  The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society.
  
  
  RESULTS
  Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%).
  
  
  CONCLUSIONS
  Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare expenditure and longer treatment periods.
authors.affiliation: Koç University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
authors.forename: Ihsan
authors.initials: I
authors.lastname: Solaroglu
authors.affiliation: Gulhane Military Medical Academy, School of Medicine, Department of Neurosurgery, Ankara, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Izci
authors.affiliation: Koç University, School of Medicine, Istanbul, Turkey.
authors.forename: H Gokce
authors.initials: HG
authors.lastname: Yeter
authors.affiliation: Koç University, School of Medicine, Istanbul, Turkey.
authors.forename: M Mert
authors.initials: MM
authors.lastname: Metin
authors.affiliation: Koç University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
authors.forename: G Evren
authors.initials: GE
authors.lastname: Keles
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007351:Insurance, Liability; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence; D008875:Middle Aged; D000069471:Neurosurgeons / Q000191:economics / Q000941:ethics* / Q000331:legislation & jurisprudence; D009493:Neurosurgery / Q000191:economics / Q000941:ethics / Q000331:legislation & jurisprudence; D014421:Turkey