Smoking is an important determinant of macroscopic skin ageing/wrinkling in older subjects. This evidence suggests that skin ageing does not clearly provide an objective measure of cumulative ultraviolet exposure, and caution should be exercised before it is used in this way. The association between smoking and wrinkling provides important information for potential use in education campaigns to reduce smoking prevalence among young people.

Objective: There has been little research on the prevalence of defensive practice within hospital settings. The aim of this report was to examine the extent of defensiveness among psychiatrists and to examine the relationship between defensiveness and seniority, as well as the effect of previous experiences on the level of defensiveness. Design: A postal questionnaire survey on defensive practice. Setting: Northern Region of England. Subjects: 154 psychiatrists in the region. Results: 96 responses were received from 48 equivalent consultants, 18 specialist registrars, and 23 equivalent senior house officers. Overall, 75% of those who replied had taken defensive actions within the past month. In particular, 21% had admitted patients overcautiously and 29% had placed patients on higher levels of observations. Junior psychiatrists were particularly prone to practise defensively. Important contributing factors included previous experience of complaints (against colleague or self), critical incidents, and legal claims. Conclusion: Almost three quarters of the psychiatrists who responded had practised defensively within the past month. The higher propensity of junior trainees to practise defensively may be attributable to their lack of confidence and experience. Experience of complaints (colleague or self) and critical incidents were important factors for defensive practice. Better and more structured training might reduce the high level of defensive practice and the way complaints and investigations are handled should be improved to maintain a truly "no blame" environment conducive to learning from past experience.A "no blame" and learning culture is essential for the delivery of quality health care, 1 2 but the close examination of practitioners' practice required for a learning culture might result in defensive practice. One definition of defensive practice is the "ordering of treatments, tests and procedures for the purpose of protecting the doctor from criticism rather than diagnosing or treating the patient". 3It has been proposed that there are both positive and negative aspects of defensive practice. 4 Examples of positive aspects might include improvements in the quality of services with more detailed explanations being given to patients and increased patient satisfaction. Examples of negative aspects might include the prescription of unnecessary treatments, increased observation levels of inpatients, and increased rates of follow up.Although defensive practice has been examined in the USA and Canada, 5-8 few such studies had been carried out in the UK until the 1990s. In high risk specialties such as obstetrics, the majority of obstetricians and midwives believe that litigation has caused a rise in defensiveness.9 However, defensive practice is common even among general practitioners, who are commonly regarded as being in a low risk specialty, with 98% claiming to have made some practice changes as a result of the possibility of a patient complaining. 4 A survey of all consultants in the Oxford Regional Heal...

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In the management of mentally ill patients, there is a tension between protecting the rights of individual patients and safeguarding public safety. The Human Rights Act 1998 emphasises on the former while two recent white papers focus on the latter. This article first examines the extent to which the Mental Health Act 1983 is consistent with the Human Rights Act. It argues that while the recent white papers exploit the gaps in the judgments given by the European courts, its compatibility with human rights is very doubtful. The practical implications of the Human Rights Act for doctors are discussed.

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