en Medical Ethics Original Research Original Research <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><b><span style="font-size:9.0pt"><span style="font-style:normal">Background: </span></span></b><span style="font-size:9.0pt"><span style="font-style:normal">Defensive medicine (DM) refers to taking or not taking clinical actions, mainly to prevent legal or reputational consequences. It increases patient and health system costs and threatens patient safety. This study aimed to provide policy options to reduce DM behaviors and was conducted in two phases.</span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Methods:</b> First, a scoping review was conducted by searching the Web of Science, PubMed, ProQuest, and Scopus databases in 2000&ndash;2023, and interventions and strategies to control DM behaviors were identified. To recognize the advantages, disadvantages, and implementation considerations, one session of focus group discussion (FGD) with experts was designed. Finally, the policies, strategies, advantages, disadvantages, and implementation considerations were refined and categorized during two expert panel sessions. </span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Results:</b> During the search, 1774 articles were retrieved. Finally, after the screening process, 58 articles were included in the study. Four main policy options were formulated: &quot;evidence-based medicine,&quot; &quot;legal reforms,&quot; &quot;promotion of professional ethics and a supportive environment,&quot; and &quot;improving the doctor-patient relationship.&quot; In the following, 13 interventions and strategies, 18 advantages, 18 disadvantages, and 21 implementation considerations were identified.</span></span></span></span></span></span></span></span><br> <span style="font-size:13pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><span style="font-style:italic"><span style="font-size:9.0pt"><span style="font-style:normal">&nbsp;&nbsp; <b>Conclusion:</b> To manage and reduce the effects of DM behaviors, different interventions at macro, organizational, and individual levels are needed. At the micro and individual levels, the enhancement of knowledge and skills is valuable. Organizational interventions that create a supportive culture and promote ethical behavior are also important.</span></span></span></span></span></span></span></span><br> &nbsp; Defensive Medicine, Defensive Practice, Conflict Of Interest, Medical Malpractice, Lawsuits 597 608 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-8269-2&slc_lang=en&sid=1 Ehsan Zarei e.zarei@sbmu.ac.ir 200319475328460089442 200319475328460089442 No Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iman Yousefi imanyousefi@hotmail.com 200319475328460089443 200319475328460089443 No School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saba Shiranirad shiraniradsaba@gmail.com 200319475328460089444 200319475328460089444 No School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Tahmineh Poursaki t.poursaki@yahoo.com 200319475328460089445 5534-6692-0006-0009 No Department of Health Service Management, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohamad Mehdi Zahmatkesh zahmatkeshm@gmail.com 200319475328460089446 200319475328460089446 No School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Pouria Farrokhi p-farrokhi@student.tums.ac.ir 200319475328460089447 200319475328460089447 Yes Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran