I have been sued for medical malpractice only once. That single incident had a profound effect on me, my family and the way I practice neurosurgery. Hence, the cover article of this issue hits close to home and brings back old feelings that were closer to the surface than I imagined.
My “incident” involved a patient operated on by a skilled neurosurgeon in another state who came to my hospital with symptoms related to his disease. We saved his life but he was left with neurological dysfunction. Despite what I thought was appropriate care, I was sued for malpractice. One of the most trying three years of my life followed.
My own malpractice case and my knowledge of others in my “day job” as chair of a nine-division department of surgery have given me some perspective that I would like to share, particularly with residents. Three factors frame my personal perspective. First, medical malpractice does occur. Second, bad results don’t equate with malpractice and good results don’t mean that the patient has had the best of care. Finally, neurosurgery can be a “high wire” act-make sure you are fully prepared and use a safety net!
A Shocking Experience
Malpractice does occur, though certainly not with the frequency suggested by the number of malpractice suits. When one finds himself being sued, as I did, something akin to the stages of the Kubler-Ross death and dying model kicks in: denial, anger, bargaining, depression and acceptance. I was shocked when I was sued. I had spoken often and in-depth with the family of the patient and documented my plan and treatment. I believed that the cause of my patient’s problem was unavoidable (an act of God), following an operation by another surgeon in another city who had treated the problem appropriately.
The three-year process of the lawsuit was fatiguing-frequent review of charts, meetings with lawyers and restless nights followed by canceled depositions. During this time my sensibilities as a surgeon were undermined and I was embarrassed. Fortunately, several of my associates rallied around me and helped with data review and preparing dispositions.
Ultimately, after three years I was “dropped” from the lawsuit and the case was settled out of court. I felt great relief, but as a believer that justice would prevail, I was dismayed. Justice had not carried the day. Not only had my hospitals’ insurance company paid a settlement but also one third of the money needed by the family of an impaired breadwinner went to the plaintiff’s lawyer, who later sued the family for a greater percentage of the settlement.
Lessons Learned
What did I learn from my exposure to malpractice that I can share with you?
Be fully aware that as a practicing neurosurgeon you are on a high wire. Tighten your lines and put up safety nets-make sure that nurses, technicians and other team members understand your goals and direction by writing legible and comprehensive orders. Always listen carefully to the patient and review diagnostic studies to make sure you have the correct diagnosis. Convey the risks to the patient and legibly document this discussion.
Bad results don’t mean that malpractice has occurred. As physicians we understand the potential inherent devastation of the diseases we treat. Unfortunately, our patients and their families do not. Furthermore, the current malpractice environment and the press coverage of medical errors have further eroded the public’s confidence in physicians.
What can you learn from my malpractice experience?
- Develop a better understanding of why lawsuits occur and become even more attentive to the pitfalls that lead to lawsuits, many of which can be avoided by practicing good patient care-diagnosis, discussion and documentation.
- Recognize that we do have a safety net-malpractice insurance. Although it is sometimes lacking in comprehensiveness, insurance coverage is there for a reason and should allow us to practicenneurosurgery without fear.
- Reach out to your colleagues for their advice and insight. It is a good feeling to know that you are not alone.
- Use the resources provided by the AANS-the Guide to Informed Consent, stories in the Bulletin, CME courses-to protect yourself against lawsuits.
- Use the lessons you learned to teach yourself and others, whether at a conference or as I did in writing a paper about the complication and presenting it at an international forum. Share your expertise, get over (but don’t forget) your malpractice experience and make lemonade out of lemons.
A. John Popp, MD, is Editor of the AANS Bulletin, Chair of the Washington Committee, and Henry and Sally Schaffer Chair of Surgery at Albany Medical College.