Views of Australian Doctors on Defensive Practice: “It’s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other.”

Professor Nola Ries1

1Faculty of Law, University of Technology Sydney, Sydney, Australia, 2Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

Background to the topic/problem: Surveys of physicians in various countries report high rates of defensive practice, where clinicians provide tests, treatments, referrals and other interventions mainly to reduce their perceived legal risks, rather than to advance patient care. Defensive practice is a deviation from sound practice and is of low value  due to the potential for harms or costs to outweigh the chance of patient benefit. There is scant qualitative research in this area, resulting in gaps in understanding the drivers of defensive practice.

Purpose of presentation: The presentation will discuss the authors’ recent (2019/20) interview study, which investigated the views and experiences of physicians in relation to defensive practice and its contribution to low value care. Interviewees (n=17) were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives.

Outcomes/conclusions: The study reveals that defensive behaviours are motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources. Interviewees cited criticism by colleagues as a particularly powerful driver, more potent than a perceived threat of legal consequences. The findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care.


Nola Ries, BA(Hons), JD, LLM, MPA, PhD (Behav Sci) has expertise in: law, ageing and health; legal aspects of health system reform; and the governance of health research. Her research is supported by national and charitable funding bodies and she has published over 60 peer-reviewed articles. Nola is qualified as a lawyer in Canada and Australia.

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