Letter: Defensive medicine

Sir: Marina Cantacuzino's article, "Birth pains which end in tragedy" (9 November) keenly illustrates the problems generated by our system of compensation for medical negligence.

Although the NHS complaints procedure is designed to give patients maximum information, the tendency of clinicians to go into "defence mode" is understandable. Admissions of culpability leave oneself open to professional censure (as witnessed in the case of the Bristol cardiac surgeons) and litigation.

Contrary to popular belief, as well as that of many solicitors, NHS trusts are not insured against medical negligence claims and it is they who foot the bill. Couple this with the fallibility of the medical profession, the impossibility of predicting and preventing many of the adverse consequences of childbirth and a system of health care provision predicated on a localised budget (NHS trusts), and is it any wonder that doctors are reluctant to own up and say sorry?

If the NHS really wants a method of telling patients the truth when things go wrong, the system of compensation for victims of medical accidents and negligence must be centralised. This would also reduce the suffering of those who have to pursue an adversarial course for years before receiving justice and fairly compensate those whose children, for example, are damaged by a medical accident and are currently entitled to very little.

Mr L J ROBERTS MRCOG

Consultant Obstetrician and Gynaecologist

Winterton, Lincolnshire