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Presumption of Guilt

Hossfeld, George MD

doi: 10.1097/01.EEM.0000406382.35107.09
You've Been Served


We all do it. It comes from years of TV and radio news using politically correct language to report on obviously guilty felons. Be honest. The last time you heard about someone being arrested and charged for cocaine trafficking, did you mentally give that person the right to be presumed innocent until proven guilty? Of course not! “They wouldn't have arrested him unless he did it” is more likely your (and my) cerebral assessment of the account. “Charged” equals “guilt.”

So it should be no surprise that our colleagues, friends, family, and neighbors feel that we “must have at least done something wrong” when they hear there are allegations of medical malpractice against us. Even our most supportive allies, while willing to listen a bit further, have a presumption of at least partial guilt in their minds. Heck, even our own mothers have trouble staying neutral!

This bias isn't just found among our non-medical neighbors, family, and friends. In an informal, hardly scientific survey of my nursing colleagues in the ED, I found there was almost universal concordance for this presumption. The same is found in most of our medical students, residents, and young attending physicians. This, among some of our most highly trained medical colleagues!

Somehow, something changes over time so that our gray-haired colleagues become a clear exception to the “guilty as charged” crowd. The reason? I'd bet dollars to donuts that they too have found themselves in the defendant chair. Statistically, it is a rare clinician in our specialty who goes five years without a suit. Granted, nearly everyone feels that his case was different from most (including yours), and any fool can see his innocence. But they are at least more willing to reserve judgment on you because they have seen how wrong the system could be in their own cases.



While clearly it isn't fair to be judged by those who have no idea of the facts, it's unlikely things are going to change anytime soon just because you and I want them to. Misery continues to love company, however, and problems shared are loads lightened. We are healers who have helped many suffering patients in lots of different ways, a role that evolves during our careers.

Now we have an opportunity to help our own. We can offer solace with the knowledge that many among us have suffered this same prejudice and offer our counsel to our anxious colleagues as they metaphorically lose their lawsuit virginity. We veterans of having received subpoenas more than once have a different perspective and an irreplaceable role to serve in comforting them. No one else has that “I know exactly how you feel” perspective than we do. We've been served, and we can help our brothers and sisters in emergency medicine. The hell with “don't talk to anyone about the case” admonitions of our lawyers. We are compassionate people with a unique perspective and chance to help our brethren, and it's the right thing to do. Maybe we even should cut those cocaine dealers a little slack … nah.

Dr. Hossfeldis an assistant professor of emergency medicine at the University of Illinois-Chicago. He is a past president of the Illinois College of Emergency Physicians, and has been involved in the legal side of emergency medicine for more than 25 years. A collection of his columns is available on the EMN web site at

© 2011 Lippincott Williams & Wilkins, Inc.