title: Inconsistencies in clinical decisions in obstetrics.
abstract: Analysis of the increasing incidence of caesarean section in an English teaching hospital over a 15-year period revealed that emergency caesarean section for the diagnosis of fetal distress in labour made a major contribution to this increasing trend. A retrospective audit of a sample of these operations by the consultants of the hospital indicated that 30% of the operations were unnecessary. There were two other disturbing findings in our audit. First, there was significant disagreement between auditors in the decision whether to do a caesarean section or not. Second, and perhaps more importantly, when faced with identical information at a different time, the auditors were inconsistent in 25% of cases. The disturbing clinical situation highlighted by this study may have implications for medical jurisprudence.
authors.affiliation: Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Barrett
authors.forename: G J
authors.initials: GJ
authors.lastname: Jarvis
authors.forename: H N
authors.initials: HN
authors.lastname: Macdonald
authors.forename: P C
authors.initials: PC
authors.lastname: Buchan
authors.forename: S N
authors.initials: SN
authors.lastname: Tyrrell
authors.forename: R J
authors.initials: RJ
authors.lastname: Lilford
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D006801:Humans; D008485:Medical Audit; D015588:Observer Variation; D011247:Pregnancy; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology