Reflexivity in Professional Practise and The Social Construction of Defensive Medicine: A Study of Discourses of Risk in Medical Practice

• Main Author: Bradder, Annette Mary
• Published: University of Liverpool 2007
• Subjects: 361
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487540

Abstract: Viewed in the context of a so-called 'compensation crisis' in the United Kingdom, defensive medicine broadly refers to a response by doctors to the risk of being sued in an action for negligence. However, the interrelated risk discourses of a 'compensation crisis' and defensive medical practice are suffused with controversy and confusion. For example, influenced by the methods of positivism, narrowly constructed 'cause' and 'effect' studies of defensIve medicine have tended to heighten controversy and confusion around the phenomenon. Accordingly, whilst some researchers seem perplexed by the findings of their studies, others appear to have simply abandoned their projects. Thus, in contrast to simplistic 'cause' and 'effect' methods a key aim in this thesis is to adopt a social constructionist, and therefore a reflexive approach to the study of medical practice and discourses of risk. Underpinned by theories of risk and control, the discussion draws upon theoretical concepts that include contestation and therefore 'reflexivity' in knowledge, 'governmentality', trust, autonomy and discretion. In acknowledging in this thesis that risks associated in public discourse with defensive medicine might have some foundation in reality, unlike most studies informed by positivism, neither defensive medicine nor risk are understood as objective realities. Rather, risk is largely considered in relation to representations of the world as being anxious or in crisis of some kind. In sum, thi~/study suggests that 'reflexivity' in professional practice and medical discourses of risk may be viewed within a nexus of social, political, technological and cultural transformation, entailing for example, the organization of trust relations, indeterminacy, and the erosion of control. The thesis is structured around seven chapters. The initial chapters ground the later analysis of data generated via semi-structured interviews with hospital doctors in England and Wales.