Risk of Malpractice Claims and Changes in Professional Autonomy: A Qualitative Study of Obstetrician-Gynaecologists in Switzerland

Abstract

Based on interviews, this article explores how obstetrician-gynaecologists in Switzerland deal with and respond to the risk of malpractice claims. It describes the factors associated with the interviewees' perceived increasing risk of litigation, as well as three attitudes towards the use of consent forms as a means of managing such a risk. This article suggests that the perceived risk of claims is closely linked to the physicians' perception of how external regulation shapes their professional autonomy.

Defensive healthcare practice: systematic review of qualitative evidence

“…On the other hand, some participants strongly rejected the idea that fear of litigation influenced their practice, arguing that they were motivated only by the interests of patients. 25 27 Participants in one study regarded the idea of defensive medicine as a ‘scarecrow’ (participant) 27 rather than an accurate description of their experience. This diversity of views may relate to the point that defensive motivations largely emerge in the ‘grey area’ (participant) 25 of clinical judgement, where there is room for legitimate disagreement about the clinically best course of action.…”

“…They felt that clinicians’ roles were distorted by an overemphasis on ‘correct’ documentation at the expense of care, particularly emotionally supportive care. 27 32 34 37 38 …”

“…‘It must be stressed that risk of malpractice claims as a true cause for concern in our sample was seldom referred to precise facts, concrete events or experiences’ (authors). 27 Rather, the fear of litigation was diffuse and may have been related to hearsay about what happens to others more than to first-hand experience, with one participant distinguishing a broader ‘indirect’ impact of litigation risk as potentially more important than the ‘direct’ impact. 25 Assing Hvidt et al ’s study reported that ‘[e]very GP had experienced being either a subject or co-subject of a patient complaint at some stage in their career’ (authors) 24 but also suggested that this was not a major driver of changes in practice, perhaps because most of these complaints were felt to be ‘unjustified or ridiculous’ (authors).…”

“… 26 33 39 At the individual clinician level, communication with patients may be an important factor in avoiding the need for defensive practices. 27 31 …”

“… 24 27 This change in norms was seen to reinforce a ‘blame culture’ where negative events are seen not as acceptable risks but as outcomes of a mistake by an identifiable individual. 27 32 37 …”