Litigation and changes in professional behaviour: a qualitative appraisal

Objective: concerns about an apparent rise in defensive clinical practice h ave centred on an alleged rise in intervention rates, particularly in mater nity care. This, the second of two articles, explores the views of a number of clinical and other practitioners concerning defensive practices. Design: qualitative using semi-structured interviews. Participants: (a) midwives and obstetricians who had responded to an earlie r postal survey, and (b) a purposive sample of others with experience in th is area. Findings: differing views about the extent of defensive practices, and abou t what constitutes defensiveness, were expressed. A discussion of these, an d of the findings of the survey reported in the first article, casts doubt on the view that defensive practices are necessarily detrimental. While an increase in caesarean sections was claimed, and justification of this optio n made, other move positive responses were also noted. Key conclusions: the definition and extent of defensive practice are diffic ult to determine. While some responses indicate that the fear of litigation leads to restrictions on client choice through interventions which are dif ficult to justify clinically, others claim that the same fear has improved standards of communication and documentation. (C) 2000 Harcourt Publishers Ltd.