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

被引:30
作者
Bassett, KL
Iyer, N
Kazanjian, A
机构
[1] Univ British Columbia, Ctr Hlth Serv & Policy Res, BC Off Hlth Technol Assessment, Vancouver, BC V6T 1Z3, Canada
[2] Univ British Columbia, Fac Law, Vancouver, BC V6T 1Z3, Canada
[3] Univ British Columbia, Fac Med, Dept Hlth Care & Epidemiol, Vancouver, BC V6T 1Z3, Canada
关键词
defensive medicine; anthropology; obstetrics; litigation;
D O I
10.1016/S0277-9536(99)00494-3
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
This payer presents an alternative perspective on defensive medicine. Defensive medicine is usually understood as arising from the effect of law on medicine through fear of litigation. Of equal significance, however, is the complementary 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 both clinical medicine and to actual or potential legal action, Excessive testing 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 developments, but of a political-economic system and the beliefs and values of a society. Defensive medicine is discussed in relation to hospital obstetrical scenarios commonly associated with fear of litigation: fetal oxygen deprivation ("distress"), which is detected using an electronic fetal monitor, and prolonged labor, known as "dystocia", The material presented is taken from a medical anthropological study of obstetrical care in rural British Columbia, Canada. Litigation fears are shown to result less from rare, albeit often devastating, allegations of malpractice than from doctors adopting a role as "fetal champions", together with the introduction of electronic monitoring 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 rights reserved.
引用
收藏
页码:523 / 537
页数:15
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