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This behaviour is counter to physicians\u2019 ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A qualitative interview study investigated the views and experiences of physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in \u2018Choosing Wisely\u2019 initiatives. Semi-structured interviews averaged 60\u00a0min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All participants (n\u2009=\u200917) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians\u2019 perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians\u2019 desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The findings call for strengthening knowledge and skills, for example, to improve clinicians\u2019 understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12910-022-00755-2","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T13:38:34Z","timestamp":1646401114000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["A qualitative interview study of Australian physicians on defensive practice and low value care: \u201cit\u2019s easier to talk about our fear of lawyers than to talk about our fear of looking bad in front of each other\u201d"],"prefix":"10.1186","volume":"23","author":[{"given":"Nola M.","family":"Ries","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briony","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"issue":"2","key":"755_CR1","doi-asserted-by":"crossref","first-page":"e034300","DOI":"10.1136\/bmjopen-2019-034300","volume":"10","author":"N Baungaard","year":"2020","unstructured":"Baungaard N, Skovvang P, Hvidt EA, Gerbild H, Andersen MK, Lykkegaard J. 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Verbal consent to participate was ethically approved by the UTS HREC and was used because all interviews but one were conducted by telephone or web-conference. The methods were carried out in accordance with relevant guidelines and regulations, including the <i>National Statement on Ethical Conduct in Human Research (2007)<\/i>\u2014<i>updated 2018<\/i> (National Health and Medical Research Council, Australia).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Participants gave consent to use de-identified data in scholarly publications and presentations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no competing interests to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16"}}