Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands.

Objectives This study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours. Design Cross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour). Setting Data were collected from eight Dutch hospitals. Participants Respondents were 160 physicians and 54 residents (response rate 25%) of