Fear of Malpractice Lawsuits High Among Neurosurgeons —With Good Reason

Megan Brooks

November 09, 2020

Most neurosurgeons have faced at least one malpractice lawsuit during their career, leading many to adopt defensive medicine tactics and some to consider leaving the practice, results of a large survey show.

"Practicing more defensive medicine usually leads to more testing for the sake of having tested something, even if you are already very much sure of its result. Ultimately this will lead to increased costs for both patients and society," study author Pravesh Gadjradj, MD, neurosurgeon at Leiden University Medical Center, Leiden, the Netherlands, told Medscape Medical News.

Results of the survey were published online November 1 in Neurosurgical Focus, a publication of the American Association of Neurological Surgeons.

"Profound and Severe" Impact

A total of 490 members of the Congress of Neurological Surgeons responded to the survey that asked about their experiences with malpractice lawsuits.  Most (84%) practice in the US and had been practicing for an average of 25 years. The top subspecialties represented were spine surgery, neuro-oncology, and neurotrauma.

Nearly 81% of neurosurgeons reported they had been named in one or more medical malpractice lawsuits. About 12% had been involved in more than 10 lawsuits. Spine surgery was the subspecialty with the most medical malpractice suits (48.4%).

Most of the medical malpractice suits had been dropped (34.5%) or settled out of court to the benefit of the plaintiff (22%).

Fifteen percent of neurosurgeons reported having been involved in lawsuits that proceeded through the courts and resulted in plaintiffs receiving more than $1 million in damages.

Forty percent of neurosurgeons said they were frequently or always concerned about being sued, and 77% said their fear had led to a change in how they practice medicine. For most (58%), this change led to the practice of defensive medicine, which mainly includes ordering more tests even when deemed unnecessary.

Given the medical malpractice environment, 59% of neurosurgeons considered referring complex patient cases, whereas 37% considered leaving the practice of medicine.

The fear of being sued (odds ratio [OR], 4.06; 95% CI, 2.53 - 6.51) and the consideration of limiting the scope of practice (OR, 3.08; 95% CI, 1.80 - 5.20) were both independently associated with higher odds of thinking about getting out of medicine.

This survey shows that the current medicolegal landscape has a "profound and often severe" impact on neurosurgeons, Gadjradj and colleagues note in their article. 

"Addressing issues of the current medical malpractice environment is therefore important, because it ensures that patients will continue to have access to high-risk care while also protecting the health professional who performs a high-risk procedure," they write.

"I think that doctors, especially young doctors, should receive more training on the process of a medical malpractice lawsuit and on how to deal with the burdens of undergoing this process," Gadjradj told Medscape Medical News.

"I also think the legal process has some room for improvement such as reducing the length of a medical malpractice lawsuit," Gadjradj said.

Attitude Adjustment

Writing in a linked editorial, neurosurgeon Richard N. W. Wohns, MD, JD, MBA, founder and president of NeoSpine in Seattle, Washington, says neurosurgeons are "in the crosshairs of plaintiff attorneys and some patients due to the high liability associated with our specialty."

Even though a medical malpractice lawsuit is an inevitability for 81% of neurosurgeons, according to this survey, "we respond as if the lawsuit is unexpected," he notes.

Wohns would like to see neurosurgeons change their mindset and recognize that lawsuits are simply "an unfortunate reality of modern medicine."

He suggests applying German philosopher Friedrich Nietzsche's dictum — "what doesn't kill me makes me stronger" — in effect, turning the malpractice case into an educational experience.

Wohns also encourages neurosurgeons to be proactive rather than reactive in the face of a malpractice case and supports teaching neurosurgical residents about medicolegal principles.

The study had no specific funding. The authors have declared no relevant conflicts of interest. Wohns is a consultant for Medtronic, SeaSpine and Alphatec.

Neurosurg Focus. Published online November 1, 2020. Full text, Editorial

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