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Emergency Medicine News:
doi: 10.1097/01.EEM.0000345612.35475.6f
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Position Statement: Use of Medical Textbooks in Malpractice Claims

Roberts, James R. MD; Marx, John A. MD

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As the editors of textbooks in emergency medicine, we are well aware that our texts and other publications in the field are often introduced as authoritative medical sources in medical malpractice litigation. Being merely written material, statements and other complex medical information in our textbook may be misinterpreted, misunderstood, misrepresented, or taken out of context when presented to a nonmedical adjudicative body.

The contentions, promulgations, and testimony of litigators and medical experts, supposedly based on our written medical texts, may not be those intended by the editors. These publications specifically were not written to be legal documents. It is easy for statements and data appearing in print to be given a totally incorrect or otherwise erroneous perspective to meet a certain need.

Our printed words are complex statements requiring extensive additional knowledge or experience to be properly and completely understood or implemented. Textbook statements and data should not be presented to a nonclinician (jury/arbitrator) as proof that malpractice has been committed or that negligent care was delivered, or conversely, that negligent or substandard care was acceptable or standard. We believe that in some instances both defense and plaintiff experts use textbooks to buttress flawed medical opinions and to spawn convoluted arguments that are not the intent of our written statements or data. Complex medical thinking cannot be grasped by laypersons by simply quoting a professional scientific publication.

We believe that injured or harmed patients should be justly compensated, and incompetent physicians should be recognized and exposed. We fully support meritorious litigation. Biased or self-serving testimony by experts on both sides of a medical malpractice case, however, is disingenuous to our patients and their loved ones, and is contrary to the principles of sound and scientific medical practice. Such actions are devastatingly harmful to the judicial system, injured parties, and to unjustly accused clinicians, and they provide protection to negligent or dangerous clinicians. We formally attest to and support the following position statement. This statement describes how our textbooks should be viewed and used by our colleagues during everyday practice and otherwise interpreted by medical experts and the courts.

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Position Statement: How a Medical Textbook Should be Viewed by the Practicing Clinician and the Judicial System

The editors of the textbooks listed below strongly believe that the complex practice of medicine, the vagaries of human diseases, the unpredictability of pathologic conditions, and the functions, dysfunctions, and responses of the human body cannot be defined, explained, or rigidly categorized by any written document. It is neither the purpose nor intent of our textbooks to serve as a final authoritative source on any medical condition, treatment plan, or clinical intervention, nor should our textbooks be used to rigorously define a rigid standard of care that should be practiced by all clinicians.

Our written word provides the physician with a literature-referenced database and a reasonable clinical guide that are combined with suggestions and opinions from selected experienced practitioners. We offer a general reference source and clinical roadmap on a variety of conditions and procedures that may confront clinicians who are experienced in emergency medicine practice. This text cannot replace physician judgment, cannot describe every possible aberration, nuance, clinical scenario, or presentation, and cannot define rigid standards for clinical actions or procedures. Every medical encounter must be individualized, and every patient must be approached on a case-by-case basis.

No complex medical interaction can possibly be reduced to the written word. The treatments, procedures, and medical conditions described in our textbooks do not constitute the total expertise or knowledge base expected to be possessed by all clinicians. Finally, many of the described complications and adverse outcomes associated with implementing or withholding complex medical and surgical interventions may occur, even when every aspect of the intervention adheres to guidelines and promulgated protocols and regimens.

In summary, while a textbook can discuss and suggest standard care as a general principle, it cannot strictly define standard of care for every potential clinical encounter. At any given moment in time, a physician's actions and interventions should be guided by realtime, unique circumstances, the current clinical and historical milieu, available resources, one's individual experience, and most importantly, clinical judgment. Care that is merely similar to or different from the care attempted to be rigorously defined in a textbook is not necessarily correct or incorrect care.

This document applies to all past and future editions of the following textbooks.

Rosen's Emergency Medicine: Concepts and Clinical Practice

John A. Marx, MD

Robert S. Hockberger, MD

Ron M. Walls, MD

James G. Adams, MD

William G. Barsan, MD

Michelle H. Biros, MD

Daniel F. Danzl, MD

Marianne Gausche-Hill, MD

Louis J. Ling, MD

Edward J. Newton, MD

Clinical Procedures in Emergency Medicine

James R. Roberts, MD

Jerris R. Hedges, MD

Arjun S. Chanmugam, MD

Carl R. Chudnofsky, MD

Catherine B. Custalow, MD

Steven C. Dronen, MD

John McManus, MD

Textbook of Pediatric Emergency Medicine

Gary R. Fleisher, MD

Stephen Ludwig, MD

Pediatric Emergency Medicine

Jill M. Baren, MD

Steven Rothrock, MD

John Brennan, MD

Lance Brown, MD

Goldfrank's Toxicologic Emergencies

Neal Flomenbaum, MD

Lewis Goldfrank, MD

Robert Hoffman, MD

Mary Ann Howland, Pharm D

Neal Lewin, MD

Lewis Nelson, MD

Emergency Medicine Procedures

Eric F. Reichman, MD

Pediatric Emergency Medicine: Concepts and Clinical Practice

David H. Rubin, MD

Edward E. Conway Jr., MD

Stuart M. Caplen, MD

Dina Kornblau, MD

Textbook of Pediatric Emergency Procedures

Christopher King, MD

Fred M. Henretig, MD

Brent King, MD

James F. Wiley, MD

John Loiselle, MD

Richard Ruddy, MD

Emergency Medicine

James Adams, MD

Erik Barton, MD

Jamie Collings, MD

Michael Gisondi, MD

Eric Nadel, MD

Peter Deblieux, MD

Neurologic Emergencies: A Symptom-Oriented Approach

Neal Little, MD

Greg Henry, MD

Andy Jagoda, MD

Thomas R. Pellegrino, MD

ECG in Emergency Medicine and Acute Care

Theodore Chan, MD

William J. Brady, MD

Richard A. Harrigan, MD

Peter Rosen, MD

Infectious Disease in Emergency Medicine

Judith C. Brillman, MD

Forensic Emergency Medicine

Jonathan Olshaker, MD

Textbook of Pediatric Education for Prehospital Professionals

Ronald A. Dieckmann, MD

Resource Manual, Pediatric Education for Prehospital Professionals

Ronald A. Dieckmann, MD

Susan Fuchs, MD

Robert Wiebe, MD

Textbook of Pediatric Education for Prehospital Professionals (American Academy of Pediatrics)

Ronald A. Dieckmann, MD

Dena Brownstein, MD

Marianne Gausche-Hill, MD

Resource Manual, Pediatric Education for Prehospital Professionals

Marianne Gausche-Hill, MD

Dena Brownstein, MD

Ronald A. Dieckmann, MD

Illustrated Textbook of Pediatric Emergency and Critical Care Procedures

Ronald A. Dieckmann, MD

Steven M. Selbst, MD

Pediatric Emergency Care Systems: Planning and Management

Ronald A. Dieckmann, MD

Pediatric Emergency Medicine: A Clinician's Reference

Ronald A. Dieckmann, MD

Emergency Medicine Procedures

Eric F. Reichman, MD

Electrocardiography in Emergency Medicine

John M. Field, MD

Michael J. Bresler, MD

Peter J. Kudenchuk, MD

Amal Mattu, MD

Robert O'Connor, MD

Scott M. Silvers, MD

Terry Vanden Hoek, MD

Textbook of Emergency Cardio-vascular Care and CPR

John M. Field MD

Michael J. Bresler, MD

Peter J. Kudenchuk, MD

Amal Mattu, MD

Robert O'Connor, MD

Scott M. Silvers, MD

Terry VandenHoek, MD

© 2009 Lippincott Williams & Wilkins, Inc.

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