Table 5 Strategies suggested by participants to prevent or reduce DM

Suggested Strategies related to modification of medical complaints managing system

Consolidation of institutions for handling patient complaints in one organization and using standard methods for managing the complaints

Strengthening the scientific aspects of the judgment in courts by increasing judges’ awareness of medical issues or seeking consultative opinions from physicians

Conducting an initial review of complaints before summoning doctors to judicial courts to ensure the necessity of starting legal proceedings

Developing and strengthening the process of handling valid complaints at the hospital or health facility level and preventing filing lawsuits in courts

Dealing with complaints as much as possible at the level of hospitals or medical centers and preventing lawsuits in courts

Excluding medical lawsuits from criminal liability

Ensuring an acceptable level of respect for physicians during the complaints assessment process

Clarifying judicial and disciplinary rules and the process of handling complaints against physicians

Making decisions about physician practice based on each patient’s unique clinical condition rather than focusing on para-clinical data

Developing the necessary sensitivity in legal and technical evaluations

Dealing with complaints from physicians based on their commitment, duties and responsibilities and not just based on the results obtained.

Strengthening a systematic view toward medical errors in complaint-handling organizations

Social strategies

Using all the available capacities, including the media to promote the health literacy level of the society

Trying to reduce the circulation of false and pseudo-scientific information in society and social media.

Correcting the false belief that referring patients to colleagues indicates incompetence

Acquainting the community with their real rights to prevent unfounded complaints

Promoting public trust in the self-regulatory system of the Medical Council to avoid referring cases to court.

Trying to reduce social harassment against physicians and to maintain and promote public trust in the medical system

Educating patients to demonstrate polite and peaceful behavior toward healthcare providers

Removing the negative role of some lawyers that encourage people to file lawsuits against physicians

Organizational-managerial strategies

Strengthening and reforming reimbursement systems such as liability insurance for physicians

Equipping hospitals, especially public hospitals and those located in provincial centers, to manage critically ill patients properly

Providing sufficient information to patients and informing them about the possibility of complications

Strengthening the necessary mechanisms to protect the right of physicians

Improving the analytical power and decision-making ability of doctors through the improvement of education and evaluation methods, including turning memory-based questions into analytical questions.

Integrating education related to consequences of DM and medical economics in the educational curriculum of medical students

Offering education on communication skills to healthcare providers

Installing appropriate monitoring systems to evaluate physicians’ practice and prescriptions

Establishing a health economics committee in each hospital to monitor and guide physicians’ activities

Enhancing the scientific capability of physicians to improve their self-confidence

Placing more emphasis on the significant role of effective communication, accurate physical examination, history-taking, and clinical reasoning in the education of medical students instead of excessive use of para clinical services

Management of patients visits in such a way that enough time can be allocated to each patient.

Reducing the working hours of physicians to reduce the odds of error

Strengthening the referral system to reduce the odds of error

Improving medical education for correct medical management and decision-making

Designing and developing medical information update systems

Designing and conducting research activities to prove the ineffectiveness of excess interventions

Inviting experienced clinical professors to seriously participate in teaching non-defensive medicine to medical students

Developing national guidelines, institutionalizing their routine use by clinicians, and using them for formal adjudication by complaints handling agencies

Increasing the motivation of physicians through revising medical tariffs and improving their financial prosperity

Creating jobs and workplaces for doctors through reinforcing support systems

Determining the permissible ceiling for para-clinical requests for different levels of doctors

Holding clinical competence courses to make physicians familiar with their rights and responsibilities towards patients, and complaint-handling organizations

Improving physicians’ professionalism through methods such as continuous education

Considering serious punitive deterrent measures for physicians who repeatedly request excess para- clinical services

Controlling the costs of excess para-clinical procedures by increasing the supervision of medical insurance

Moving towards eliminating a direct financial relationship between physicians and patients

Improving the educational system in terms of providing accurate and correct documentation training for performed procedures

Accurate assessment of applicants to medical education courses to ensure that they do not have personality disorders

Providing legal support for physicians through hiring lawyers in health centers

Creating a balance between medical equipment in medical centers and society’s expectations from physicians

Training members of complaints handling commissions to treat physicians respectfully

Formulating treatment plans and standard procedures for each hospital proportional to its equipment and characteristics by experienced professors

Providing more financial and legal support for physicians regarding admission and treatment of high-risk patients

Providing grounds for cooperation and collaboration of all health policymakers and stakeholders in the Ministry of Health, Medical Council, Legal Medicine Organization, and Judiciary to address DM

Research into underlying factors of the prevalence of DM in Iran and using other countries’ experiences to reduce DM

Changing the payment system to physicians instead of payment based on type and number of interventions to a fixed payment