title: 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.
authors: Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Wayne.cunningham@otago.ac.nz
authors: Wayne
authors: W
authors: Cunningham
authors: Hamish
authors: H
authors: Wilson
mesh_terms: D001291:Attitude of Health Personnel; D003675:Defensive Medicine; D034462:Dissent and Disputes; D006801:Humans; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care; D012752:Shame