Complaints, shame and defensive medicine

Abstract

While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment. There is also evidence that this style of practice is low quality in terms of decision-making, cost and patient outcomes. Western medical practice is based on biomedicine: determining medical failure using the underlying, taken-for-granted assumptions of biomedicine can potentially contribute to a response of shame after an adverse outcome or a complaint. Shame is implicated in the observable changes in practising behaviour after receipt of a complaint. Identifying and responding to shame is required if doctors are to respond to a complaint with an overall improvement in clinical practice. This will eventually improve the outcomes of the complaints process.

Characteristics of complaints resulting in disciplinary actions against Danish GPs

“…The risk of receiving a patient complaint case seriously impacts on the work of medical doctors [1]. Professional self-esteem comes into play and especially in general practice the continuous patient–doctor relationship is at stake.…”

Plastic Surgery as a Problem-solving Surgery

“…As a matter of fact, we believe that this phenomenon should be recognized under "defensive medicine, " a term that is being increasingly used. [4][5][6] We believe that a difference can be made by providing training on the scope of plastic surgery and the type of consultations that can be requested of PRAS.…”

The threat of litigation as a possible barrier to innovation

“…Despite the no‐fault compensation model, New Zealand has not been immune to claims of defensive medicine. Defensive medicine in New Zealand has tended to be linked to doctors changing their usual practice to avoid a complaint, rather than to avoid litigation . Defensive medicine has been described as an undesirable outcome of the complaints process in New Zealand …”

“…It has been argued in New Zealand that defensive medicine is driven less by externalised factors and more by internalised mechanisms, such as the notion of shame . There is some intuitive attraction in that; a health professional's reputation is everything – and likely more important to the individual than whether an indemnity insurer needs to pay out significant sums to settle litigation.…”