An article published in today’s Medical Journal of Australia argues that red tape is threatening professional independence.

It also discouraged treatment tailored to individual patients.

Sydney obstetrics and gynaecology professor Hans Peter Dietz and University of Newcastle biostatistician Barrie Stokes point to a proliferation of rules and red tape in NSW Health.

Compliance with directives telling obstetricians when and how to deliver babies was mandatory, under the threat of disciplinary action and loss of indemnity cover, the journal article said.

The authors said a recent directive requiring a reduction in caesarean section rates to 20per cent by 2015 was an illusory and possibly dangerous target.

The present rate for NSW is 30.2per cent and for Hunter New England 26.7per cent.

Also concerning was a departmental policy that elective or pre-labour caesarean section must not routinely be carried out before 39weeks gestation, due to risk of respiratory morbidity in babies.

‘‘[The policy] effectively forbids doctors in NSW public hospitals to schedule routine elective caesarean section before 39weeks,’’ the article said.

‘‘Anyone doing so risks disciplinary action and may forfeit indemnity cover.’’

The timing of elective caesarean delivery was complex, the authors said.

Patients should be assessed and treated as individuals, with clinicians using relevant prior information from evidence-based sources, rather than replicating action outlined in a government document.

‘‘No doctor should ever just blatantly stick to the guideline and ignore the particulars of a person before them,’’ Mr Stokes said.

‘‘Doctors should always have the right to depart, in their considered medical opinion, from a guideline if what they see is not typical or usual, in order to treat this particular patient right.’