Assistant Physicians Knowledge and Attitudes about Defensive Medical Practices, Work-Related Stress and Burnout Levels

Introduction: Defensive medicine is the practice of physicians to use the unnecessary procedures for diagnosis and treatment in order to protect themselves against medical malpractice cases, or to avoid taking the responsibility of high-risk medical practices which are likely to result in a malpractice case. The present study was carried out to reveal the knowledge and attitudes of research assistants working in internal and surgical medical sciences at Dicle University Medical Faculty Hospital about the defensive medicine applications and the factors affecting work-related stress and burnout levels. Method: The sample of this descriptive-cross-sectional type of study was designed by proportional layer method. The questionnaire, which included the sociodemographic data form, the defensive medicine applications attitude scale and the maslach burnout inventory, was applied to 200 physicians. Results: Of all the participants whose mean age was 29.4±3.0, 70.5%(n=141) were male, 56%(n=112) were married. The frequency of positive and negative defensive medicine was found as 98%(n=196) and 92 % (n=184)  respectively. The points of defensive medicine were significantly high in the males, those working at surgical departments, those in the first two years of the specialist training in medicine, those the malpractice case opened about and smokers. The level of work-related tension was significantly high in the ones working at surgical departments, ones who keep watch for eight times or more per month, those the malpractice case opened about, smokers and alcohol users. The average points which the physicians took from Maslach Burnout Inventory were determined as 31.57±11.67 for emotional exhaustion, 11.75±6.49 for desensitization and 29.46±7.72 for personal accomplishment. Conclusion: In our study, it was concluded that most of the research assistants were not satisfied with the choice of profession and specialty, their knowledge of defensive medicine concept was inadequate and their high burnout rates were found in all burnout dimensions. It was seen that the burnout levels of those who applied more to defensive medicine were higher. Giris: Defansif tip, hekimlerin kendilerini tibbi malpraktis davalarina karsi korumak amaci ile tani ve tedaviye yonelik gereksiz islemler kullanmalari veya malpraktis davasi ile sonuclanma riski yuksek tibbi uygulamalarin sorumlulugunu almamak icin, bu tur uygulamalardan kacinmalaridir. Bu calisma, Dicle Universitesi Tip Fakultesi Hastanesinde, dahili ve cerrahi tip bilimlerinde calisan arastirma gorevlisi hekimlerin, defansif tip uygulamalari hakkindaki bilgi ve tutumlari, ise bagli gerginlik ve tukenmislik duzeylerini etkileyen faktorleri ortaya koymak amaciyla yapilmistir.  Yontem: Tanimlayici-kesitsel tipteki bu calismanin orneklemi, orantili tabakali yontemle olusturulmustur. Sosyodemografik veri formu, defansif tip uygulamalari tutum olcegi ve Maslach tukenmislik olcegini iceren anket, 200 hekime uygulanmistir.  Bulgular: Yas ortalamasi 29,4±3,0 olan katilimcilarin, % 70,5’i (n=141) erkek, %56’si (n=112) evliydi. Pozitif ve negatif defansif tip sikligi, sirasiyla %98 (n=196), %92 (n=184) olarak bulunmustur. Defansif tip puanlari, erkeklerde, cerrahi bilimlerde calisanlarda, uzmanlik egitiminin ilk 2 yilindakilerde, hakkinda malpraktis davasi acilanlarda ve sigara kullananlarda anlamli derecede yuksek bulunmustur. Ise bagli gerginlik duzeyi, cerrahi bilimlerde calisanlarda, ayda 8 ve uzeri sayida nobet tutanlarda, hakkinda malpraktis davasi acilanlarda, sigara kullananlarda, alkol kullananlarda anlamli derecede yuksek bulunmustur. Hekimlerin, Maslach tukenmislik olceginden aldiklari puan ortalamalari, duygusal tukenme icin 31,57±11,67, duyarsizlasma icin 11,75±6,49, kisisel basari icin 29,46±7,72 olarak belirlenmistir. Sonuc: Calismamizda, arastirma gorevlisi hekimlerin buyuk kisminin meslek ve uzmanlik dali seciminden memnun olmadiklari, defansif tip kavrami hakkinda bilgilerinin yetersiz ve tum tukenmislik boyutlarinda, yuksek tukenmislik oranlarinin oldugu sonucuna varilmistir. Defansif tibbi daha fazla uygulayanlarin tukenmislik duzeylerinin daha yuksek oldugu gorulmustur.