Jeff Segal, MD, JD, FACS
A recent study in New England Journal Medicine shed light on the frequency of litigation against doctors. For high risk specialties, such as neurosurgeons and cardiothoracic surgeons, the annual rate approached 20% a year. For general surgeons, the rate was 15% per year; for plastic surgery, the rate was 13% per year.
The same study noted that plaintiffs received an award in only 1 of 5 cases.
A more recent study in the Journal of American College of Surgeons examined the effect this litigation had on surgeons.
Seven thousand surgeons (29%) in the professional society returned surveys.
Involvement in a recent malpractice suit was reported by 24.6% responding surgeons. Surgeons involved in a recent malpractice suit were younger, worked longer hours, had more night call, and were more likely to be in private practice.
Not surprisingly, recent malpractice suits were strongly related to burnout, depression, and recent thoughts of suicide. Hours worked, nights on call, subspecialty, and practice setting were also independently associated with recent malpractice suits. Surgeons who had experienced a recent malpractice suit reported less career satisfaction and were less likely to recommend a surgical or medical career to their children.
These conclusions are not exactly news to surgeons. But, it drives home the message that our professional liability system is badly broken. The consequences of a lottery system where only one in five patients win have profound consequences for our healthcare system. One question our healthcare system should address is who will take care of us if there are fewer surgeons to answer the call. Fixing our medico-legal tort system would help ensure a brighter future for surgeons – indeed, all physicians.
Wonder how the study ‘missed’ the impact on anesthesiologists who, after all, are physicians & do appear on the same patient chart as the surgeons.
Being on the patient chart in a liability suit generally gets the anesthesiologist at least named in the surgeon’s suit & not infrequently dismissed later.
Given the percentages cited, my record of no patient having named me or filed suit against me since I began doing propofol ketamine anesthesia nearly 20 years ago is a probable endorsement of patients being reluctant to sue doctors they like.
Propofol is a happy drug that permits REM sleep under anesthesia. In case anyone missed the Conrad Murray Michael Jackson manslaughter trial, propofol is not a sleep aid.
Friedberg’s Triad
Measure the brain
Preempt the pain
Emetic drugs abstain
Several of my surgeon colleagues give their preop patients copies of my ‘Getting Over Going Under, 5 things you MUST know before anesthesia,’ as a way to help dispel the fears of anesthesia.
The non-profit Goldilocks Anesthesia Foundation wholesales copies for office use.
Contingency litigation has created an atmosphere which promotes this lottery style justice. There are respectable med mal firms that only take cases where there is clearly a deviation from the standard of care. But as with all business, the bottom feeders are always there ready to try for a quick settlement. I believe gradually the world is catching on and hopefully in the future a standards based method of practice will be adopted. Imagine what that could do for lowering the cost of medicine.
Medical justice has identified the most egregious injustice in the system. The hired gun who will lie on the stand for the correct fee. It’s telling how they shy away from cases where they know they must stick to testifying based on the standard of care (the truth). And when they don’t it’s also nice to see them get their asses kicked by the state boards.
Dear Medical Justice,
The information of the study confirms previous data. Tort reform at the state levels is continuously on the legislature agenda. Some states tort statues have been challenged in the courts, specifically related to maximum on pain and suffering. In recent years the federal senate has passed federal tort reform statues, however, they failed in the house.
The best way to deal with the tort issue is obviously on the federal level and we can only hope that gets through the system and into law before we retire.
I have a question that experts have conveyed varied opinions. Arbitration consent forms and the srbitration process has been shown, at least in California, to decrease the number of malpractice cases. I looked into this and this is true for medical non-cosmetic cases.
The question I have is in cosmetic cases when patients have an issue the cosmetic result, do not want you to revise them, and threaten to or present a legal suit for <$10,000, it would seem in these cases, NOT to have an arbitration agreement. It seems to me that the expense of the entire expert witness and comprhensive malpractice process, would defer plaintiff attorneys from taking these cases just from a limited financial return on their behalf.
The only risk is that id the surgeon gets a major complication and litigation, the arbitration pathway is no longer on option. What is your opinion?
Most telling is the constant, pervasive fear experienced by all physicians when speaking to patients. It matters not if the patient is insulting, demaning and demanding to the doctor, holding the doctor in obvious disrespect. The responses must always be measured, and weighed so as not to goad the patient to take the next step as a suit.
Additionally, what other career path will openly tell you and demonstrate that you cannot charge for increases in expenses, costs in seeing a patient, dressings, time spent or weekend work. It should be well noted that if matters persist, the medical world in the US will turn to the UK and Italian systems and the bright and talented will seek jobs elsewhere.
lawsuits are blamed on bad surgeons and has been used in Florida to create 3 strikes and u r out What this really means is that you better do bread and butter safe surgery and nothing else no cutting edge and this is affecting academics now hospitals and lawyers attack mainly surgeons on grounds of being disruptive and ruining careers and this is a cash cow for psychologists abduction yet we ignore published data that over 70% of these people are incompetent then look at the recent example of a disruptive cardiologist sent out by the north Carolina board of medicine yell me what u really think