title: Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons' medical practice and on health service.
abstract: Increased knowledge in disease causes and progression, along with technological and technical advancements in their diagnosis and treatment, have led to increased expectations from physicians by patients and their relatives. The condition of "second victim" is known to affect caregivers that commit an error, and seriously impairs private life and subsequent practice. Besides, a condition has been described, the clinical-judicial syndrome, affecting caregivers at any moment during a medical litigation. In this scenario, physicians have started to practice "defensive medicine", aimed at protect themselves from liability rather than actually advancing care of patients. This paper represents the first review on defensive medicine with specific focus on surgery in an Italian setting. We reviewed the literature on the topic, with particular focus on surgeons and Italian current status, and provide the readers with a snapshot on these relevant issues, proposing strategies to prevent and reduce the practice of defensive medicine, and to support patients and physicians suffering from medical errors.
authors.affiliation: , Via Giotto 60, 81031, Aversa, CE, Italy. liapellino@gmail.com.
authors.forename: Italia Maria
authors.initials: IM
authors.lastname: Pellino
authors.affiliation: Unit of General Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. gipe1984@gmail.com.
authors.forename: Gianluca
authors.identifier: http://orcid.org/0000-0002-8322-6421
authors.initials: G
authors.lastname: Pellino
mesh_terms: D003675:Defensive Medicine; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence; D019300:Medical Errors / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000191:economics; D013315:Stress, Psychological / Q000150:complications; D066231:Surgeons / Q000523:psychology
keywords: Adverse event; Clinical-judicial syndrome; Defensive medicine; Error; Surgery