Objective: The aim of the study is to explain the concept of defensive dentistry and to investigate the knowledge, attitudes and behaviors of oral and maxillofacial surgeons in Turkey regarding defensive dentistry. Material and Methods: In this cross-sectional descriptive study, a defensive dentistry behavior scale was used. One hundred and two oral and maxillofacial surgeons were included in the study. Results: In this study, it was found that 43.2% of oral and maxillofacial surgeons practiced 'high', 37.3% of 'moderate' and 19.6% of 'low' level defensive dentistry. Positive defensive dentistry scores of oral and maxillofacial surgeons were found to be higher than negative dentistry scores. There was no significant difference in positive and negative dentistry practices according to the demographic characteristics of the participants (age, gender, marital status, working experiences, working place). Of oral and maxillofacial surgeons, 80.4% stated that they never heard about the concept of defensive dentistry and 91.2% stated that they did not know the content of this concept. Conclusion: This study revealed that in Turkey, oral and maxillofacial surgeons performed a moderate level of defensive dentistry. In order to reduce defensive dentistry practices, oral and maxillofacial surgeons should be provided with a suitable and safe working environment in which they can practice effectively on the basis of law and ethical principles.
Keywords: Defensive medicine; malpractice; ethics; dentistry; oral and maxillofacial surgery
Amaç: Çalışmanın amacı, defansif diş hekimliği kavramını açıklamak ve Türkiye'deki ağız ve çene cerrahlarının defansif diş hekimliği konusundaki bilgi, tutum ve davranışlarını incelemektir. Gereç ve Yöntemler: Bu kesitsel tanımlayıcı çalışmada, defansif diş hekimliği davranış ölçeği kullanıldı. Çalışmaya, 102 ağız ve çene cerrahı dâhil edildi. Bulgular: Bu çalışmada, ağız ve çene cerrahlarının %43,2'sinin 'yüksek', %37,3'ünün 'orta' ve %19,6'sının 'düşük' düzey defansif diş hekimliği uyguladığı görüldü. Ağız ve çene cerrahlarının pozitif defansif diş hekimliği puanları, negatif defansif diş hekimliği puanlarından daha yüksek bulundu. Katılımcıların demografik özelliklerine (yaş, cinsiyet, medeni durum, iş deneyimleri, çalışma yeri) göre pozitif ve negatif diş hekimliği uygulamalarında anlamlı bir fark yoktu. Ağız ve çene cerrahlarının %80,4'ü, defansif diş hekimliği kavramını hiç duymadıklarını ve %91,2'si bu kavramın içeriğini bilmediklerini belirttiler. Sonuç: Bu çalışma, Türkiye'de ağız ve çene cerrahlarının orta düzeyde defansif diş hekimliği yaptığını ortaya koydu. Defansif diş hekimliği uygulamalarını azaltmak için ağız ve çene cerrahlarına, hukuk ve etik ilkeler temelinde etkin hekimlik yapacakları uygun ve güvenli bir çalışma ortamı sağlanmalıdır.
Anahtar Kelimeler: Defansif tıp; malpraktis; etik; diş hekimliği; ağız ve çene cerrahisi
- Tancredi LR, Barondess JA. The problem of defensive medicine. Science. 1978;200(4344):879-82.[Crossref] [PubMed]
- Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-17.[Crossref] [PubMed]
- Onesti A. [Defensive dentistry and low-risk clinical practice] [São Paulo]: University of São Paulo; 2010. (Date of access: 4.12.2019)[Link]
- U.S. Congress, Office of Technology Assessment, Defensive Medicine and Medical Malpractice, OTA-H--6O2 (Washington, DC: U.S. Government Printing Office, July 1994). (Date of access: 4.12.2019)[Link]
- Kelleher M. State-sponsored dental terrorism? Br Dent J. 2017;223(10):759-64.[Crossref] [PubMed]
- Al Hassan A. Defensive dentistry and the young dentist - this isn't what we signed up for. Br Dent J. 2017;223(10):757-8.[Crossref] [PubMed]
- Patel K. Young dentists: breaking the silence. Br Dent J. 2018;224(10):767-8.[Crossref] [PubMed]
- UK dental practices are struggling to fill roles. Br Dent J. 2018;224(2):60.[Crossref] [PubMed]
- FHDC. Half of NHS young dentists heading for the exit. (Date of access: 4.12.2019)[Link]
- Hancocks S. Defensive dentistry. Br Dent J. 2005;199(9):543. (Date of access: 4.12.2019).[Crossref]
- Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139.[Crossref] [PubMed]
- Traina F. Medical malpractice: The experience in italy. In: Clinical Orthopaedics and Related Research. Vol 467. Springer New York; 2009:434-42.[Crossref] [PubMed] [PMC]
- Kohn LT, Janet M. Corrigan and MSD. To Err Is Human. Building a Safer Health System. 1999;6(2).[Crossref]
- Nalliah RP. Trends in US malpractice payments in dentistry compared to other health professions - dentistry payments increase, others fall. Br Dent J. 2017;222(1):36-40.[Crossref] [PubMed]
- United Nations. Universal Declaration of Human Rights. (Date of access: 26.4.2020)[Link]
- WMA - The World Medical Association. WMA Declaration of Lisbon on the Rights of the Patient. (Date of access: 26.4.2020)[Link]
- Resmî Gazete (7.10.1920, Sayı: 23420). (Date of access: 26.4.2020) Hasta Hakları Yönetmeliği, s.67-76.[Link]
- Resmî Gazete (7.10.1920, Sayı: 23420) sayılı Hasta Hakları Yönetmeliğinde Değişiklik Yapılmasına Dair Yönetmelik. (Date of access: 26.4.2020).[Link]
- Türkiye Sigorta Birliği. Tıbbi Kötü Uygulamaya İlişkin Zorunlu Mali Sorumluluk Sigortası Genel Şartları. (Date of access: 27.4.2020)[Link]
- Yılmaz A, Demiral G, Şahin G, Yener O, Kocataş A, Bölük S. [The impact of Turkish PenalCode (TPC) which entered into force in 2005 on surgeons]. J For Med. 2013;27(3):158-72.[Crossref]
- Yılmaz K, Polat O, Kocamaz B. [The legal analysis of defensive medicine acts]. TAAD. 2014;5(16):19-51.[Link]
- Gökcan HT. Tıbbi Müdahaleden Doğan Hukuki ve Cezai Sorumluluk. 2. Baskı. Ankara: Seçkin Yayıncılık; 2014.
- Yılmaz K. Defansif Tıp. 1. Baskı. Ankara: Seçkin Yayıncılık; 2014.
- Hiyama T, Yoshihara M, Tanaka S, Urabe Y, Ikegami Y, Fukuhara T, et al. Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol. 2006;12(47):7671-5.[Crossref] [PubMed] [PMC]
- Healthcare J. A Costly Defense: Physicians Sound off on the High Price of Defensive Medicine in the U.S.[Link]
- Reuveni I, Pelov I, Reuveni H, Bonne O, Canetti L. Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists. BMJ Open. 2017;7(3):e014153.[Crossref] [PubMed] [PMC]
- Panella M, Rinaldi C, Leigheb F, Knesse S, Donnarumma C, Kul S,et al. Prevalence and costs of defensive medicine: a national survey of Italian physicians. J Health Serv Res Policy. 2017;22(4):211-7.[Crossref] [PubMed]
- Başer A, Kolcu G, Çığırgil Y, Kadınkız B, Öngel K. [Evaluation of the opinions of family doctors working in Izmir Karsiyaka district on defensive medical practices]. Smyrna Tıp Dergisi. 2014:16-24.[Link]
- Solaroglu I, Izci Y, Yeter HG, Metin MM, Keles GE. Health transformation project and defensive medicine practice among neurosurgeons in Turkey. PLoS One. 2014;9(10):e111446.[Crossref] [PubMed] [PMC]
- Küçük M. Defensive medicine among obstetricians and gynaecologists in Turkey. J Obstet Gynaecol. 2018;38(2):200-5.[Crossref] [PubMed]
- Calikoglu EO, Aras A. 'Defensive medicine among different surgical disciplines: a descriptive cross-sectional study. J Forensic Leg Med. 2020;73:101970.[Crossref] [PubMed]
- Göcen Ö, Yılmaz A, Aslanhan H, Çelepkolu T, Tuncay S, Dirican E. [Assistant physicians' knowledge and attitudes about defensive medical practices, work-related stress and burnout levels]. TJFMPC. 2018;12(2):77-87.[Crossref]
- Başer A, Başer Kolcu Mİ, Kolcu G, Tuncer Ö, Altuntaş M. [Dentists' views about defensive dentistry: a cross-sectional study]. Tepecik Eğit Hast Derg. 2014;24(2):103-9.[Crossref]
- Zhu L, Li L, Lang J. The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress. BMJ Open. 2018;8(2):e019752.[Crossref] [PubMed] [PMC]
- Kiani M, Sheikhazadi A. A five-year survey for dental malpractice claims in Tehran, Iran. J Forensic Leg Med. 2009;16(2):76-82.[Crossref] [PubMed]
- Henderson SJ. Risk management in clinical practice. Part 11. Oral surgery. Br Dent J. 2011;210(1):17-23.[Crossref] [PubMed]
- Karaarslan B, Şirin Karaarslan E, Çelik S, Ertaş E, Çelik N. [Evaluation of malpractice cases in dentistry which was discussed in high health council during 2 1-2 7 years]. Turkiye Klinikleri J Dental Sci. 2010;16(2):142-8.[Link]
- Başer A, Başer Kolcu Mİ, Kolcu G, Gök Balcı U. [Validity and reliability of the Turkish version of the defensive medicine behaviour scale: preliminary study]. Tepecik Eğit Hast Derg. 2014; 24(2):99-102.[Crossref]
- Eijkman MA, Assink MH, Hofmans-Okkes IM. Defensive dental behaviour: illusion or reality? Int Dent J. 1997;47(5):298-302.[Crossref] [PubMed]
- Sekhar MS, Vyas N. Defensive medicine: a bane to healthcare. Ann Med Health Sci Res. 2013;3(2):295-6.[Crossref] [PubMed] [PMC]
- Healthcare Finance News. Defensive medicine adds billions to annual U.S. healthcare costs. (Date of access: 18.7.2020)[Link]
- Williams S. On the defensive. Africa Casebook 2011; 19(8-1): 1.[Link]
- Healey B. Physicians, defensive medicine and ethics. Proceedings of the Academy of Health Care Management. 2010;7(1).[Link]
- Şahin B, Alcali Ö. [Defense Medical Concept and the Effect of Defensive Medical Applications on the Legal Liability of The Physician] TAAD, 2020; 11(41): 483-510.[Link]
- Büken E, Ornek Büken N, Büken B. Obstetric and gynecologic malpractice in Turkey: incidence, impact, causes and prevention. J Clin Forensic Med. 2004;11(5):233-47.[Crossref] [PubMed]
.: Process List