TY - JOUR T1 - Complaints, shame and defensive medicine JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 449 LP - 452 DO - 10.1136/bmjqs.2011.051722 VL - 20 IS - 5 AU - Wayne Cunningham AU - Hamish Wilson Y1 - 2011/05/01 UR - http://qualitysafety.bmj.com/content/20/5/449.abstract N2 - 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. ER -