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Gretchen Glesner, MD
Littleton, Colo

JAMA. 1991;265(18):2338-2339.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

Dr Stafford¹ raises a disturbing question echoed by the media and the public: are private physicians performing an unnecessary number of repeat C-sections simply to line their pockets? While I do not deny the need for some individual and collective soulsearching on this issue, I think there are two important nonclinical factors not addressed by this study that come into play more often than financial incentives. These are fear of litigation and patient preference.

In a teaching setting, there is a shared responsibility for patient care and, therefore, far less personal fear of litigation than in the one-to-one relationship of patient and private physician. In the private setting, this leads to overcautious interpretation of fetal monitor tracings, as well as a tendency to "take the easy way out" for patients exhausted from a long and difficult labor. There is a consensus that one can always . . . [Full Text PDF of this Article]

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