COMMENTARY

Let Patients See Visit Notes?; also, Medical Device Risks

Wayne J. Guglielmo, MA

Disclosures

January 13, 2012

In This Article

Surgeon/Columnist Shares Her Malpractice Story

In a personal follow-up to a much-cited November study in Journal of the American College of Surgeons on the emotional toll of liability suits on doctors, UCLA surgeon and New York Times columnist Pauline W. Chen, MD, writes of her own malpractice ordeal.

In the study, researchers found that malpractice lawsuits against surgeons are not only more common than typically supposed but also more personally damaging. Of the more than 7000 surgeons responding to the survey, roughly 1700 (about 25%) said they had been involved in a recent malpractice suit. Researchers found that doctors in this group were younger, worked longer hours, had more night call duty, and were more likely to be in private practice. For them, the personal toll exacted by their malpractice suit tended to take the form of burnout, depression, and recent thoughts of suicide. Such doctors also reported less career satisfaction and a greater reluctance "to recommend a surgical or medical career to their children."

Dr. Chen, a young surgeon herself, experienced at least some of these symptoms after she learned that she had been named in a malpractice lawsuit. As she says in her New York Times article of December 20, 2011, "The family of a patient I had seen briefly a year before believed that a colleague's decision not to operate hastened her demise. Now their lawyers, combing through the medical records, believed that a single sentence in my note brought that doctor's decision into question. As a second or maybe even third decision, I had written that the woman was a 'possible candidate' for surgery."[3]

Dr. Chen acknowledges that when she saw the woman "she was a possible candidate, but only tenuously so." After this, "[the woman's] health deteriorated so rapidly that by the time she finished seeing all the specialists and returned to her original surgeon, the chances of surviving any treatment, no matter how heroic, were almost nil."

Anxiety and Self-doubt

Despite knowing this, Dr. Chen went through a protracted period of self-doubt, often hedging on her write-ups and assessments. "And I wondered," she writes, "if my colleagues knew, if the blot on my record had already soaked through the fabric of my professional reputation."

The lawsuit ultimately was dropped, saving Dr. Chen the experience of going to court or even of meeting with any lawyers.

Still, she says, the November study brought back a flood of bad memories. After sifting through several proposed antidotes for postlitigation physician burnout, defensive medicine, and sometimes additional errors, she says, "But change will require looking at malpractice reform in a new way, one that gives weight not just to the economic costs but to the ways reform might affect how patients and doctors interact."

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