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Editor: Roger V Clements
406 pp. Price £31.95 ISBN 0-85315-480-6 (p/b)
London: RSM Press.
Money paid out for clinical negligence now accounts for a sizeable part of National Health Service spending. The trend to litigation is increasing and the specialty of obstetrics and gynaecology suffers particularly because of high awards for brain damage in babies. Numerous books and courses offer advice on how to avoid such litigation, under the titles risk management and clinical governance. However, some clinicians feel that risk management is a drain on time and resources, without much benefit to the patient. This view, I believe, is partly due to a mistaken idea that risk management is synonymous with defensive medicine. Defensive medicine is a sloppy mode of practice whereby patients are overinvestigated so that the clinician escapes criticism if the outcome is unsatisfactory. (Most investigations yield some false-positives which then lead to further tests, which may be hazardous to the patient.) Risk management, by contrast, is about identifying the risks, deciding on practical strategies to minimize them and also deciding whether they are worth taking. Individuals and departments reach differing conclusions, hence the variations in management policies nationwide.
Risk Management and Litigation in Obstetrics and Gynaecology is very clear about this distinction. It is ambitious in dealing not only with risk assessment but also with practical procedures such as operative gynaecological techniques and instrumental vaginal delivery. The section on prediction and management of shoulder dystocia is clear and concise and outlines the labour-ward management of this serious obstetric emergency in a way that will greatly help obstetric practitioners. I was less impressed by some other recommendations; for instance, to perform an instrumental vaginal delivery with any part of the head palpable abdominally is contrary to the guidelines of the Royal College of Obstetricians and Gynaecologists. The reason for this discrepancy, doubtless, is the rapid change in clinical practice, but it does illustrate why a clinician must keep up to date. The book is amply referenced and there are numerous tables and illustrations. The chapters are of a length that can be read at a single sitting. Some will be of most interest to clinicians in a subspecialty such as urogynaecology. I suggest that the next edition should include a chapter on postnatal care, a common source of complaints poorly covered in most texts.
This book will be of interest to obstetricians and gynaecologists at all levels, as well as to those senior consultants responsible for risk management.