An exploratory study of the impact of the medico-legal environment on surgical practice in Ireland

Tumelty, Mary-Elizabeth; Cinnamond, Kaitlyn; Hannigan, Ailish; Tierney, Sean; Spain, Eimear

An exploratory study of the impact of the medico-legal environment on surgical practice in Ireland

Files

Defensive_Medicine_CORA.pdf(344.16 KB)

Accepted Version

Date

2021-10-28

Authors

Tumelty, Mary-Elizabeth

Cinnamond, Kaitlyn

Hannigan, Ailish

Tierney, Sean

Spain, Eimear

Publisher

Brill Academic Publishers

Published Version

10.1163/15718093-bja10056

Abstract

Defensive medicine describes behaviours engaged in by physicians, for the purposes of averting the threat of medical negligence litigation and/or complaints. Defensive practice typically encompasses ‘assurance’ or ‘avoidance’ behaviours, or ‘positive’ or ‘negative’ defensive medicine. Assurance behaviours include, for example, meticulous notetaking and ordering further clinically unnecessary tests, whereas avoidance behaviours encompass actions such as refusing to engage with a patient perceived to be high-risk. Whilst such practices may be understandable, defensive medicine is problematic for a number of reasons: it may result in a lower standard of patient care, where for example, a patient is exposed to unnecessary risk(s); and it can increase healthcare costs, which in turn limits resources. Drawing on the findings of a survey of surgeons in Ireland, this study investigates the existence of defensive practices, and explores the impact of the civil and regulatory responses to patient safety incidents on surgical practice. Given the increasing emphasis on patient safety and cultivating a “no-blame” culture both nationally and internationally, the findings of this research illustrate the tension between the current medico-legal and regulatory environment and medical practice, with implications for quality and safety.

Keywords

Defensive medicine , Liability , Litigation , Patient safety

Citation

Tumelty, M. E., Cinnamond, K., Hannigan, A., Tierney, S. and Spain, E. (2021) 'An exploratory study of the impact of the medico-legal environment on surgical practice in Ireland', European Journal of Health Law, 28. doi: 10.1163/15718093-bja10056