title: The determinants of defensive medicine in Italian hospitals: The impact of being a second victim.
abstract: BACKGROUND
  Defensive medicine affects healthcare systems worldwide. The concerns and perception about medical liability could lead practitioners to practise defensive medicine. Second victim is a healthcare worker involved in an unanticipated adverse patient event. The role of being second victim and the other possible determinants for defensive medicine is mostly unclear.
  
  
  OBJECTIVE
  To study the condition of being second victim as a possible determinants of defensive medicine among Italian hospital physicians.
  
  
  METHODS
  A secondary analysis of the database of the national survey study on the prevalence and the costs of defensive medicine in Italy that was carried out between April 2014 and June 2014 in 55 Italian hospitals was performed for this study. The demographic section of the questionnaire was selected including the physician's age, gender, specialty, activity volume, grade and the variable being a second victim after an adverse event.
  
  
  RESULTS
  A total sample of 1313 physicians (87.5% response rate) was used in the data analyses. Characteristics of the participants included a mean age 49.2 of years and 19.4 average years of experience. The most prominent predictor for practising defensive medicine was the physicians' experience of being a second victim after an adverse event (OR=1.88; 95%CI, 1.38-2.57). Other determinants included age, years of experience, activity volume and risk of specialty.
  
  
  CONCLUSIONS
  Malpractice reform, effective support to second victims in hospitals together with a systematic use of evidence-based clinical guidelines, emerged as possible recommendations for reducing defensive medicine.
authors.affiliation: Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Panella
authors.affiliation: Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy. Electronic address: cml.rinaldi@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Rinaldi
authors.affiliation: Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Leigheb
authors.affiliation: Department of Translational Medicine, School of Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Donnarumma
authors.affiliation: Center for Applied Medical Statistics. University of Gaziantep, Gaziantep, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Kul
authors.affiliation: Center for Health Services and Nursing Research, School of Public Health, University of Leuven, Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Vanhaecht
authors.affiliation: Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Di Stanislao
mesh_terms: D000059:Accidents / Q000191:economics / Q000523:psychology*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003675:Defensive Medicine / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D016365:Liability, Legal / Q000191:economics; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence; D019300:Medical Errors / Q000191:economics / Q000523:psychology*; D008505:Medical Staff, Hospital / Q000523:psychology*; D008511:Medicine; D008875:Middle Aged; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D012306:Risk; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*
keywords: Costes sanitarios; Defensive medicine; Health care costs; Medical malpractice; Medicina defensiva; Negligencia médica; Second victim; Segunda víctima