Litigation and changes in professional behaviour: A qualitative appraisal

Objective: Concerns about an apparent rise in defensive clinical practice have centred on an alleged rise in intervention rates, particularly in maternity 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 earlier postal survey, and (b) a purposive sample of others with experience in this area. Findings: Differing views about the extent of defensive practices, and about what constitutes defensiveness, were expressed. A discussion of these, and 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 option made, other more positive responses were also noted. Key conclusions: The definition and extent of defensive practice are difficult to determine. While some responses indicate that the fear of litigation leads to restrictions on client choice through interventions which are difficult to justify clinically, others claim that the same fear has improved standards of communication and documentation.