Defensive medicine during hospital obstetrical care: a byproduct of the technological age

This payer presents an alternative perspective on defensive medicine. Defen sive medicine is usually understood as arising from the effect of law on me dicine through fear of litigation. Of equal significance, however, is the c omplementary influence of medicine on law through technological innovation, and, more importantly, the way that medicine and law develop dialectically . Each shapes the other in establishing the standards of care central to bo th clinical medicine and to actual or potential legal action, Excessive tes ting owing to fear of litigation indicates that defensive medicine is being practised in a particular setting, but it does not explain why this is so. To understand why defensive medicine occurs and why it is so troubling to clinicians requires an understanding, not only of medical and legal develop ments, but of a political-economic system and the beliefs and values of a s ociety. Defensive medicine is discussed in relation to hospital obstetrical scenarios commonly associated with fear of litigation: fetal oxygen depriv ation ("distress"), which is detected using an electronic fetal monitor, an d prolonged labor, known as "dystocia", The material presented is taken fro m a medical anthropological study of obstetrical care in rural British Colu mbia, Canada. Litigation fears are shown to result less from rare, albeit o ften devastating, allegations of malpractice than from doctors adopting a r ole as "fetal champions", together with the introduction of electronic moni toring technology. The paper concludes by asserting that, rather than being in an adversarial relationship, medical practice and associated litigation primarily work together to reinforce each other, and the social conditions in which defensive medicine occurs. (C) 2000 Elsevier Science Ltd. All rig hts reserved.