Recently, I learned of a surgeon on the west coast who received a “love letter” from an attorney. By love letter, I mean a demand for several hundred thousand dollars.


The surgeon took care of a patient and recommended surgical treatment. The patient did not want any down-time and opted for conservative care, fully understanding the surgeon thought surgery was a better option. Still, the surgeon believed that the patient could try conservative management over time, and if need be, more aggressive treatment could be done down the road.


The patient did not improve.


The attorney’s “love letter” alleged the surgeon should have fixed a minimally displaced fracture acutely in the operating room. The fracture was splinted and followed. The fracture healed with an angular deformity (a deformity that causes no symptoms in most patients).


The patient left the practice and saw another doctor – a surgeon who practiced in a different specialty. The new doctor had limited background, training, and experience in the procedure the original surgeon recommended. In contrast, the original surgeon had extensive experience.


The second surgeon performed the procedure; osteotomy and internal fixation.


The patient had a significant complication and the second surgeon had to re-do the procedure.


Likely, the second surgeon threw the first surgeon under the bus. He likely said something like “if only your first doctor had repaired it properly…you never would have needed more extensive surgery or experienced any complications.” Who knows?


The medical record is sparse regarding the patient’s affirmative choice for conservative care. Had the doctor added one sentence – stating he recommended surgery acutely, but the patient wishes conservative care for the following reason….. – the love letter would not have been sent. If this evolves into a lawsuit and the patient is deposed, he will need answer truthfully about his choice. I don’t see this evolving into a full-throttle lawsuit. But, one sentence added to the record would have eliminated the risk.