Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
BMJ Qual Saf. 2011 May;20(5):449-52. doi: 10.1136/bmjqs.2011.051722. Epub 2011 Mar 15.
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.
虽然投诉程序旨在改善医疗保健，但一些医生在收到投诉后似乎会采取防御性医疗措施。这种反应不仅发生在采用侵权法医学系统的国家，也发生在专业责任较低的国家。防御性医疗是基于避免医疗事故责任，而不是对调查和治疗进行风险效益分析。也有证据表明，这种做法在决策、成本和患者结果方面的质量较低。西方医学实践基于生物医学：使用生物医学的潜在、默认的假设来确定医疗失败，可能会导致在不良结果或投诉后产生羞耻感。在收到投诉后，观察到的实践行为的变化表明羞耻感的存在。如果医生要在临床实践中对投诉做出整体改进，就需要识别和应对羞耻感。这最终将改善投诉程序的结果。
