The current state of defensive medicine and its association with empathy: a cross-sectional study among graduate students in Guangxi, China.

BACKGROUND: Defensive medicine arises partly from strained physician-patient relationships and concerns related to medico-legal issues. While most existing research has focused on practicing physicians, relatively little is known about defensive medicine among master's students. This group is at a critical transitional stage from student to physician, making it essential to understand their behaviors and attitudes. Therefore, this study aimed to examine the prevalence of defensive medical practices among clinical master's students and to explore their association with empathy, with the ultimate goal of informing medical education and training for future physicians. METHODS: A cross-sectional survey was conducted among first- to third- year master's students enrolled between July 2022 and July 2024. Data were collected through an online questionnaire administered via a web-based platform. The survey gathered demographic information and included the self-developed Defensive Medical Practice Scale (DMS) and the Jefferson Scale of Empathy (JSE). Descriptive statistics, t-tests, and ANOVA were employed to assess group differences. Associations between variables and factors related to defensive medical practices were examined using Spearman correlation, stepwise linear regression, and random forest models. RESULTS: A total of 295 valid responses were analyzed, including 95 males (32.2%) and 200 females (67.8%). The mean score on the DMS was 34.19 (SD = 4.21), while the mean score on the JSE was 106.09 (SD = 13.96). The most frequently reported defensive behavior was obtaining additional informed consent (M = 4.79, SD = 0.56). Defensive medical practices were negatively correlated with empathy (r = - 0.209, p < 0.001). Regression analyses showed that lower empathy, prior adverse medical experiences (e.g., severe complications, patient death, or disputes), and certain specialties were significant predictors of defensive medical practices (p < 0.05). CONCLUSIONS: This study demonstrates that empathy is a key determinant of defensive medical practices among master's students. The findings underscore the importance of systematically embedding empathy cultivation within medical curricula. Enhancing empathy education has the potential to mitigate defensive medical behaviors, strengthen physician-patient relationships, and improve both the humanistic orientation and the overall quality of healthcare delivery.