Intended for healthcare professionals

Letters Lessons from the front line

We need to change the culture around complaints procedures

BMJ 2017; 359 doi: (Published 22 November 2017) Cite this as: BMJ 2017;359:j5313
  1. Tom Bourne, consultant gynaecologist
  1. Queen Charlotte’s and Chelsea Hospital, London W12 0HS, UK
  1. tbourne{at}

Sokol says that lawsuits encourage “better, safer practice.”1 But litigation and complaint investigations have a pernicious effect by creating a culture of fear, and, as Berwick states, “Fear is toxic to both safety and improvement.”2

Physicians understandably respond by practising defensively. We found that >80% of doctors responding to a survey admitted to “hedging” (for example, overinvestigating or …

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