Experiences of neurological surgeons with malpractice lawsuits

Abstract

OBJECTIVEAs a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits.METHODSA survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one’s own practice of medicine.RESULTSThere were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53–6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80–5.20) were both independently associated with higher odds of considering leaving the practice of medicine.CONCLUSIONSThe current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.

How defensive medicine is defined in European medical literature: a systematic review

“…The studies were published during 1972–2021. Among those, the 50 European studies included in this systematic review2 3 5–8 16–20 22–25 34–68 were published during 1995–2020 with a steep increase in publications during the recent years (table 1, figure 2).…”

“…One study included data from 74 countries 56 and one study only mentioned the continents included. 61 The studies encompass 39 medical specialtes with general practice (n=14), obstetrics and gynaecology (n=12), emergency department (n=9), general surgery (n=8) and anaesthesiology (n=8) emerging as dominant sources of research data. Forty-eight studies (96 %) have a cross-sectional design, of which 37 (74%) are surveys, 6 (12%) are interview studies and 3 (6%) are combined survey and interview studies.…”

Neurosurgeons’ opinions on discussing sexual health among brain tumor patients: Room for improvement?

“…With only 137 respondents, there is a high chance that selection bias has been introduced. Other surveys among members of the CNS had response rates ranging from 8.0 to 11.5% [22][23][24]. Selection bias could not be formerly tested because of the lack of demographics of nonresponders to make comparison with responders.…”

Editorial. What doesn’t kill you makes you stronger

“…Even though a medical malpractice lawsuit is an inevitability for 81% of neurosurgeons at some point throughout our careers, according to Gadjradj et al, 1 we respond as if the lawsuit is unexpected. If we change our mindset and recognize that this is simply an unfortunate reality of modern medicine, and apply Nietzsche's dictum, we can turn the malpractice case against us into an educational experience from which we learn to be even better neurosurgeons.…”

“…Gadjradj et al aptly describe the repercussions neurosurgeons suffer in "Experiences of neurological surgeons with malpractice lawsuits." 1 We are in the crosshairs of plaintiff attorneys and some patients due to the high liability associated with our specialty. When a lawsuit is filed against us, our responses range from adopting the practice of defensive medicine to referring difficult patient cases elsewhere and limiting the scope of procedures offered to leaving the practice of medicine due to the legal landscape.…”