Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-07-11 DOI:10.1227/neu.0000000000003620

François Waterkeyn, Chibuikem A Ikwuegbuenyi, Simon A Balogun, Myriam Thys, Romani R Sabas, Hervé M Lekuya, Dominique Vanpee

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Abstract

Background and objectives: This study investigates the prevalence and determinants of defensive medicine among neurosurgeons in Sub-Saharan Africa (SSA). It examines how economic, cultural, and legal factors unique to SSA influence these practices, providing insights to guide regional policy-making and medical education.

Methods: A cross-sectional survey of 71 neurosurgeons in SSA was conducted via WhatsApp, LinkedIn, and conferences. The questionnaire, adapted to the SSA context from a Canadian study, explored demographics, practice types, liability profiles, defensive behaviors, and perceptions of the medicolegal environment. Data were analyzed using descriptive statistics in R software.

Results: Among 71 respondents, 91.5% were men, and 29.6% were undergoing residency or fellowship training. All respondents reported engaging in at least 1 defensive medical behavior, with varying degrees of frequency. Common strategies included patient discussions (24.2%) and specialist referrals (16.7%). Economic and resource limitations constrained practices such as ordering imaging (17.5%) and prescribing medications (10.8%). Despite perceived medicolegal risks, 93% of participants reported no lawsuits in the past 3 years.

Conclusion: Defensive medicine among neurosurgeons in SSA is less prevalent and intense than in high-income regions. Unique economic constraints, cultural norms, and weaker legal pressures limit defensive behaviors. These findings highlight the need for context-specific policies and educational strategies to balance medicolegal risk management with resource limitations in SSA.

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神经外科中的防御医学：撒哈拉以南非洲的经验。

背景和目的：本研究调查了撒哈拉以南非洲（SSA）神经外科医生中防御医学的患病率和决定因素。它研究了SSA独特的经济、文化和法律因素如何影响这些做法，为指导区域政策制定和医学教育提供见解。方法：通过WhatsApp、LinkedIn和会议对71名SSA神经外科医生进行横断面调查。该问卷根据加拿大一项研究的SSA背景进行了调整，探讨了人口统计学、实践类型、责任概况、防御行为和对医学法律环境的看法。采用R软件进行描述性统计分析。结果：在71名受访者中，91.5%是男性，29.6%正在接受住院医师或研究员培训。所有受访者都报告至少有1种防御性医疗行为，频率不同。常见的策略包括患者讨论（24.2%）和专家转诊（16.7%）。经济和资源限制限制了诸如订购影像学检查（17.5%）和开药（10.8%）等做法。尽管存在医疗法律风险，93%的参与者报告在过去3年中没有提起诉讼。结论：与高收入地区相比，SSA地区神经外科医生的防卫性用药不那么普遍和强烈。独特的经济约束、文化规范和较弱的法律压力限制了防御行为。这些发现突出表明，需要根据具体情况制定政策和教育策略，以平衡SSA的医疗法律风险管理与资源限制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.