Antonella Vimercati, Pantaleo Greco, Anila Kardashi, Cristina Rossi, Vera Loizzi, Marco Scioscia, Giuseppe Loverro
Choice of cesarean section and perception of legal pressure
Objective. To evaluate the perception of “Defensive Medicine” by hospital based obstetricians and the influence
of this attitude on the choice of cesarean
delivery.
Subjects and Methods. Questionnaire sent by mail to
a sample (76) of obstetricians of general district, teaching
and university hospitals in a region of southern Italy
(Puglia). Doctors were selected as the head, the most
senior and the most junior specialist of each department.
Independent variables of the study were considered as
demographic data of the subjects, years of service, interest
in private practice, size of the hospital, background
cesarean section rate, personal and site of work
exposure to legal claims. Outcome measures were experience
and confidence in training for operative vaginal
and breech delivery, use of the partogram in labor,
opinion about a trial of labor after a previous cesarean
section and about cesarean section on request, personal
perception of defensive medicine. Univariate and multivariate
analysis of data were performed.
Results. The response rate was 83%. According to our
data, seniority in service meant confidence in and request
of more teaching of obstetrics manoeuvres, size of hospitals
was positively related to amore rationale approach of
the diagnosis of dystocia, heads of units were keener to
accept the patient's wish for a cesarean section. Doctors
with large private practices were less likely to be sued and
the perception of legal pressure was directly related to the
rate of cesarean section in each unit.
Discussion. Defensive Medicine is a reality that encompasses
all categories of doctors in this survey. The only
differences were in the rate of perception of legal pressure.
We believe that residential programs should be
modified in order to improve specialists' understanding
of malpractice problems and that the patient-doctor relationship
should be ameliorated in public hospitals.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 28, 04/2000
Pages: 111 - 117
Show full article (external site)
Show all available items of this journal
Search
