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