We are grateful to Dr. Akwari for her thoughtful comments about our recent article on resident malpractice professionalism education. As she quite generously commented, replacing fear with knowledge is the primary goal of our professionalism seminar.
We strongly agree with her suggestion that in-depth and ongoing patient-doctor communication is crucial, especially when the possibility of malpractice has occurred. We do discuss patient-doctor communication at length during many of our other professionalism seminar sessions—not just the one on malpractice. Our malpractice session is limited to one hour, so we try to maximize the time discussing “the nuts and bolts” of the litigation process—topics previously quite foreign to surgical residents (as shown by our preseminar survey).
In the research we discussed in our article, our specific focus was a retrospective analysis of over 18,000 surgical procedures from July 2001 through May 2008 at NYU Medical Center, to learn what malpractice actions had been brought against the Department of Surgery during the period studied. Our research made clear to us that surgical malpractice usually comes to light long after the patient leaves the hospital, when maintaining the patient-doctor relationship may be beyond repair and ongoing care has changed to alternate providers.
Our malpractice professionalism seminar focused on the specific causes we identified for surgical malpractice: improper documentation, inadequate informed consent, technical error, and others. Regarding Dr. Akwari's interpretation of Regenbogen and colleagues'1 findings, while it is clear that most of the technical errors occurred in routine operations with experienced surgeons, as we had said, she is correct to emphasize the issue of complexity, since the errors happened “under conditions of increased patient complexity or systems failure.” Upon reflection, we agree with Dr. Akwari that some of our terminology was imprecise. We should have been clearer in stating that most surgeons report being sued—not most doctors. And finally, we certainly agree with her comment that
reflection, and sober analysis from the perspective of our special relationship to patients and society, can help us make appropriate use of our legal advocates, interact with legal adversaries, or act with balance when we, a colleague, or a family member is a defendant.
Mark S. Hochberg, MD
Professor of surgery and vice chairman for education, New York University School of Medicine, New York, New York (Dr. Hochberg is married to a federal judge); Mark.firstname.lastname@example.org.
Adina L. Kalet, MD, MPH
Associate professor of medicine and surgery, New York University School of Medicine, New York, New York.
Sondra R. Zabar, MD
Associate professor of medicine, New York University School of Medicine, New York, New York.
1 Regenbogen SE, Greenberg CC, Studdert DM, Lipsitz SR, Zinner MJ, Gawande AA. Patterns of technical error among surgical malpractice claims: An analysis of strategies to prevent injury to surgery patients. Ann Surg. 2007;246:705–711.