Psychiatrists 'driven by fear'

Are all prescriptions in the patient's best interest?

Fear of being sued or pilloried in the media is forcing many psychiatrists to take the safe treatment option - even if it is not necessarily the best for the patient.

A study has found that three out of four psychiatrists practised so-called defensive medicine in the month prior to being questioned.

All of medicine has been quite profoundly affected by the need to be aware of the risk of litigation

Dr Julian Beezhold

The findings follow research published last month that showed the number of men compulsorily detained under the Mental Health Act rose by 40% over the last decade.

Perhaps unsurprisingly it was junior doctors who were most likely to be over-cautious.

But some psychiatrists admitted that previous experience of complaints had left them determined to avoid legal action or criticism from the media.

Defensive medicine is the practice of opting for treatments, tests and procedures with the primary intention of protecting the doctor from criticism, rather than diagnosing or treating the patient.

Recent action

Researchers received completed questionnaires from 96 psychiatrists practising in the north of England. These included consultants, non-consultant grades and trainees.

Of these 71 had taken defensive action within the past month. Twenty-one percent had admitted patients overcautiously and 29% had placed patients on higher levels of observations.

The researchers, from the Learning Disability Service in Stockton and the University of East Anglia, warned the results suggested defensive medicine was even more likely in other branches of medicine, as psychiatry is regarded as a low risk specialty.

They argue that better and more structured training might reduce the high level of defensive practice.

They also call for reform of the way complaints are dealt with. Apportioning blame is often not as important as learning from past experience, they say.

Profound impact

Dr Julian Beezhold, of the Royal College of Psychiatrists, said his colleagues' decisions were prone to come under intense scrutiny, for instance during homicide inquiries when a mentally ill patient has committed murder.

"All of medicine has been quite profoundly affected by the need to be aware of the risk of litigation."

Dr Beezhold, a specialist registrar at Addenbrooke's Hospital, Cambridge, said defensive medicine might partly explain the rise in compulsory detentions.

"There is no obvious reason why that should be so, there has been no increase in the number of people who are mentally ill," he said.

"This is almost certainly a tangible response to the risk of litigation.

"It is very difficult to see individual cases where detention was not warranted, but if you look at the overall trend once has to wonder if it is the result of the impact of defensive medicine."

Dr Beezhold agreed with the researchers that the introduction of a no fault system of compensation for medical injuries would go a long way towards tackling the problem.

The research is published in the Postgraduate Medical Journal.