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Republished original viewpoint: Complaints, shame and defensive medicine
  1. Wayne Cunningham,
  2. Hamish Wilson
  1. Department of General Practice, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Wayne Cunningham, Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin PO Box 913, New Zealand; Wayne.cunningham{at}


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.

  • Complaints
  • shame
  • defensive medicine
  • biomedicine
  • adverse outcomes
  • decision-making
  • healthcare quality improvement
  • medical error
  • patient safety
  • quality of care

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  • This is a reprint of a paper that first appeared in BMJ Qual Saf, May 2011, Volume 20, pages 449–452.

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.