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Logo of postmedjPostgraduate Medical JournalCurrent TOCInstructions for authors
 
Postgrad Med J. Nov 2002; 78(925): 671–673.
PMCID: PMC1742562
Defensive practice among psychiatrists: a questionnaire survey
K Passmore and W Leung
Stockton Learning Disability Service, UK. kirsty_passmore/at/hotmail.com
Abstract
Objective: There has been little research on the prevalence of defensive practice within hospital settings. The aim of this report was to examine the extent of defensiveness among psychiatrists and to examine the relationship between defensiveness and seniority, as well as the effect of previous experiences on the level of defensiveness.
Design: A postal questionnaire survey on defensive practice.
Setting: Northern Region of England.
Subjects: 154 psychiatrists in the region.
Results: 96 responses were received from 48 equivalent consultants, 18 specialist registrars, and 23 equivalent senior house officers. Overall, 75% of those who replied had taken defensive actions within the past month. In particular, 21% had admitted patients overcautiously and 29% had placed patients on higher levels of observations. Junior psychiatrists were particularly prone to practise defensively. Important contributing factors included previous experience of complaints (against colleague or self), critical incidents, and legal claims.
Conclusion: Almost three quarters of the psychiatrists who responded had practised defensively within the past month. The higher propensity of junior trainees to practise defensively may be attributable to their lack of confidence and experience. Experience of complaints (colleague or self) and critical incidents were important factors for defensive practice. Better and more structured training might reduce the high level of defensive practice and the way complaints and investigations are handled should be improved to maintain a truly "no blame" environment conducive to learning from past experience.
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