2.2.2.3 Understanding defensive behaviour better

There is a rich body of empirical research in defensive medicine that focuses on the relationship of liability to defensive behaviour. There is a consensus that physicians amend their behaviour to reduce malpractice liability, ranging from assurance behaviour to avoidance behaviour with regard to medical treatments and practices.1 Several empirical studies demonstrate that it is the perceived rather than the actual liability risk that motivates physicians’ defensive behaviour.2 These studies show that physicians associate lawsuits with a feeling of dread and distress. Lawsuits are regarded as unpredictable and uncontrollable events with disastrous consequences both personally and financially. The impact of these consequences are said to produce a statistically irrational level of risk aversion. Liability risks have therefore been classified as ‘dread risks’ (risks that are so strongly associated with negative effects that their low probability is neglected (‘probability neglect’) in order to express the overestimation of these risks.3 The abovementioned studies thus suggest that the defensive attitude of physicians has little rational basis, given the actual liability risks. Not only does the excessive defensiveness lead to rising health care costs, it also stimulates negligent behaviour among physicians when the urge to minimise personal liability risks prevails over the need to provide effective and adequate health care or even access to healthcare for patients.4