Legal and Ethical Aspects of Practicing Defensive Medicine in Cardiac Diseases

Abstract

Background: Defensive medicine practices can adversely affect patient care quality and inflate healthcare costs, particularly within high-risk specialties such as cardiology. Objective: This study aims to examine the legal and ethical aspects of practicing defensive medicine among cardiologists, evaluating its prevalence, underlying motivations, and impact on clinical decision-making. Method: A cross-sectional study was conducted at Barasat Government Medical College, Kolkata, from January 2023 to December 2023. A total of 100 cardiologists participated, completing structured questionnaires designed to assess defensive medicine behaviors, legal concerns, and ethical perspectives. Data were analyzed using descriptive statistics, chi-square tests for categorical variables, and multivariate logistic regression to identify significant predictors of defensive practices. The significance level was set at p < 0.05. Result: Among the 100 cardiologists surveyed, 70% reported engaging in defensive medicine practices. Specifically, 60% frequently ordered unnecessary diagnostic tests, 40% avoided high-risk procedures, and 30% referred patients to other specialists to mitigate litigation risks. Logistic regression revealed that fear of malpractice lawsuits (Odds Ratio [OR]=3.5, 95% Confidence Interval [CI]: 2.0-6.1, p=0.001) and inadequate legal support (OR=2.8, 95% CI: 1.5-5.2, p=0.005) were significant predictors of defensive medicine. Additionally, 65% of respondents acknowledged that defensive practices conflicted with patient-centered care principles, while 50% indicated that such practices led to a 20% increase in departmental healthcare costs due to redundant procedures. An economic analysis estimated that defensive medicine contributed to an annual rise of INR 2 million in operational costs. Furthermore, 55% of cardiologists reported heightened emotional stress related to potential litigation, correlating with a 15% decrease in job satisfaction scores (p=0.02). Quality of life assessments showed a 25% decline among those frequently practicing defensive medicine compared to their counterparts (p=0.03). Conclusions: Defensive medicine is highly prevalent among cardiologists at Barasat Government Medical College, Kolkata, primarily driven by legal anxieties and ethical conflicts. Addressing these issues is essential to mitigate unnecessary medical interventions, control healthcare costs, and enhance the quality of patient care.