PONE-D-23-01241The practice of defensive medicine among Jordanian physicians: a cross sectional study.PLOS ONE

Dear Dr. Al-Balas,

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‘Al-Balas Q. Received the fund.

Grant No.: 20200641

Funder: Jordan University of Science & Technology, Deanship of Reserch.

https://www.just.edu.jo/Deanships/DeanshipofResearch/Pages/Default.aspx

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Respectable Authors

Thank you for considering a significant area of research related to defensive medicine among physicians. Your results are of interest but your manuscript needs revisions as follows;

- Please add the data collection period in the abstract and the main text.

- The sample size is small. What is your reason?

- The abstract section, please add a summary of all results in the results section (prevalence, reasons, and strategies).

- Add data regarding the validity and reliability of the questionnaire. How did you adopt the Panella questionnaire?

- How do you conclude about the cost? In my opinion, and based on your results, discussing cost is not a reasonable conclusion at all.

- The abstract's aim is not similar to the aim at the end of the introduction.

- Please report the results separately by the public and private sectors.

- Please remove: from headings and subheadings sections.

- What is your sampling method? Please add a section regarding sample size and sampling method.

- There is a conflict regarding working seating. Public and private? or private, government, and university-based?

- I can not access the figures because the format is Tiff and not presented to me.

- Your discussion is week. You must discuss all your results with the results of the other related research and state the similarity and differences with reasons. Please add more updated research in this field. For example, this is a good scoping review that you can benefit it in your discussion section:

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review

- The number of references is low.

Cheers

Reviewer #2: In the current study, authors have examined the practice of defensive medicine among Jordanian physicians. The manuscript is well-written and worth publishing. I have some minor comments:

- In the Introduction, I suggest that authors add information about Jordan in terms of population and health sectors.

- In the Methods, authors should provide information on the sample size calculations, sampling strategy, and distribution of the sample according to targeted sites.

- The IRB approval number and the name of the IRB should be added to the Method section.

- Authors should identify which targeted places are considered governmental and which ones are private.

- In Table 1, subcategories should be arranged in an ascending manner. For example, age and experience. Same thing applies to some of the other tables.

- Figures were not available in the PDF file

Reviewer #3: This cross-sectional study was conducted to evaluate the prevalence of Defensive Medicine (DM) practice among physicians in Jordan. The study sheds light on the reasons behind DM practice and potential strategies to reduce it. It is interesting to note that unfavorable legislation was reported as the primary reason for DM practice, and laboratory exams for diagnostic purposes were found to be the most practiced behavior.

The study also highlights the concern of physicians about increasing patterns and costs associated with DM in the future. Overall, this study provides valuable information about the prevalence and predictors of DM practice in a developing country like Jordan.

The article is very well organized, concise enough and from where I am standing, clearly meets its goals. Congratulations on that. That's why I hope that in the future articles like this one can have some impact at higher levels.

I will only a few recommendations and all of them are minor English sentence making/vocabulary suggestions. For example, line 243 "Findings from this study shows".

Another minor suggestion is to think about the sections organization if there is a better way to organize the content of introduction and discussion. In this regard, I suggest to include and discuss relevant references such as doi: 10.1213/ANE.0000000000003395 (By examining a current group of closed malpractice claims in which obstetric anesthesiology was the primary defendant, the authors explored the correlation between contributing factors, patient injuries, and legal outcomes).; doi: 10.3390/healthcare9081012 (a more recent paper on litigations in Italy, see your reference number 11); doi: 10.1016/j.spinee.2022.08.012. Epub 2022 Aug 23.

(In a comprehensive review of legal claims reported in the United States over the past 70 years, researchers examined the risks of litigation associated with sports-related spinal injuries. They found that such injuries can be catastrophic, especially in collision sports like football, and can result in substantial legal claims. Negligent supervision and premises liability were reported as the most common legal claims, and the median payout for all cases was approximately $780,000.).

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Reviewer #1: Yes: Morteza Arab-Zozani

Reviewer #2: Yes: Omar F. Khabour

Reviewer #3: No

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The practice of defensive medicine among Jordanian physicians: a cross sectional study.

PONE-D-23-01241R1

Dear Dr. Qosay Al-Balas,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Alessandro Vittori, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I am pleased to inform you that your manuscript may be accepted.

Kind Regards

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Respectable Authors

Thank you for your clarification. Your manuscript is acceptable in this fashion.

Cheers

Reviewer #2: Authors have answered my comments. I am satisfied with the revision. I recommend acceptance of the manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Morteza Arab-Zozani

Reviewer #2: No

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