Table 3.

Reasons for practicing defensive medicine and strategies to reduce defensive medicine reported in the included studies

Reasons for practicing DM		Possible solutions and strategies to reduce DM
Main themes	Codes	Main themes	Codes
Patient-related reasons	• Increasing number of lawsuits against physicians • Physicians’ self-perceived threats from patients • Past disputes with patients • Avoid potential conflict with patients • Patient pressure factors	Structured training and education	• Improve Physicians training educating and about appropriate care in clinical surroundings • Implementation of awareness programs about the DM phenomenon • Establish and disseminate clinical protocols or guidelines targeting widespread DM actions • Support the regular use of evidence-based medicine and structured care • More training in problem-solving techniques • Health curriculum should specifically address litigation issues
Organization-related reasons	• Increasing malpractice premiums • Decreasing provider reimbursement • Inadequate medical and or organizational procedures • Inadequate malpractice and liability coverage • Inadequate hospital support for liability issues • Inadequate legislation protecting doctors	Physician–patient relationship	• Restore trust in physician -patient relationships • Innovate harmony and alliance between physician and patient • More communication with patients and their families • Induct social workers to participate in managing the conflict between physicians and patients • Promoting the ethical values of physicians
Physician-related reasons	• Solo practice • Previous experience of complaints and legal claim for themselves and colleagues • A perceived legal risk • Fear and concerns over medical liability • Physicians Low-income • Concerns about financial and possible legal consequences • Lack of self-confidence • Lack of specialized knowledge • The weekly activity volume • Ineffective physician–patient relationship • Legal protection • Feared compromising their professional reputation and or career	Reform of the health system	• Redistribution of the health procedures between various healthcare professionals, and enhance multidisciplinary collaborations • A comprehensive examination of main factors and the expenditure on DM, and a better understanding of the current shortages in the healthcare system • Establish clinical records management • Better use of the risk management techniques • Establish clinical auditing system and health debriefing • Physician reward system reform • Forming a committee to study malpractice cases to avoid recurrence • Performing a compensation procedure for a patient who has suffered a medical injury
Society-related reasons	• Concerns about media attention • Believe in working in a blame-free culture • A general negative context surrounding negligence claims against physicians	Reform the liability system	• Ways of complaints and inquiry should be upgraded. • Introduce complaints committee in hospitals • Filtration of cases at an early stage to prevent the court as much as possible • Establish alternatives to the existing litigation system • Establishment of health courts and specialized courts with trained judges in the field of health care