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Published on: September 20, 2018
Complaints, shame and defensive medicine
Wayne Cunningham1, Hamish Wilson
1Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Wayne.cunningham@otago.ac.nz
BMJ Quality & Safety
|March 29, 2011
Summary
Doctors may practice defensive medicine, avoiding necessary care, after complaints due to fear of liability. Addressing the shame associated with medical complaints can improve clinical practice and patient outcomes.
Area of Science:
- Medical ethics
- Healthcare quality
- Psychology in medicine
Background:
- The healthcare complaints process aims to improve medical services.
- Some physicians adopt defensive medicine post-complaint, prioritizing liability avoidance over patient benefit.
- This practice is observed across different medicolegal systems.
Purpose of the Study:
- To explore the link between medical complaints, defensive medicine, and shame in Western biomedical practice.
- To identify shame as a key factor influencing physician behavior after complaints.
- To propose addressing shame for improved clinical practice and complaint outcomes.
Main Methods:
- The study reviews existing literature on defensive medicine and the psychological impact of medical complaints.
- It analyzes the role of Western biomedicine's assumptions in physician responses to adverse outcomes.
- Qualitative analysis of physician behavioral changes post-complaint is discussed.
Main Results:
- Defensive medicine, driven by malpractice concerns, leads to suboptimal decision-making, increased costs, and poorer patient outcomes.
- The biomedical framework can induce shame in physicians following negative events or complaints.
- Shame is identified as a significant driver of behavioral changes in medical practice.
Conclusions:
- Responding to and identifying shame is crucial for physicians to improve clinical practice after a complaint.
- Addressing the emotional impact of complaints can enhance the effectiveness of the healthcare complaints process.
- Integrating psychological support can mitigate defensive medicine and improve patient care.
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