Malpractice lawsuits and change in work in Japanese surgeons

Background: The risk of lawsuits causes surgeons stress and is associated with defensive medicine. It is possible that some surgeons withdraw from surgery because of malpractice lawsuits, although the actual impact of lawsuits is not clear. This study evaluated changes in work and medical practices involved in lawsuits, as well as support they receive. Materials and methods: A total of 115 surgeons who had been involved in lawsuits in Japan were eligible to participate. Participants were surveyed about changes in work because of lawsuits, the influence of lawsuits on medical care, defensive medicine, and their opinions on support they received. Results: A total of 30 surveys were collected. Six surgeons changed work: five had lost their lawsuits and the remaining one had a settlement. Surgeons felt that lawsuits imposed a time burden (100%) and caused emotional strain (96%). Surgeons made a number of conscious changes to their medical care after lawsuits, including over care (27%) and a hesitation to use high-risk treatments (39%). They had positive opinions of support they received from the legal counsel (89%), the hospital director (73%), supervisors (65%), and colleagues (57%). Surgeons who changed work were significantly more likely to engage in defensive medicine, including over care and hesitation, than those who had not changed work. Support from the legal counsel was negatively correlated with over care and hesitation. Conclusions: Given the significant influence of lawsuits on surgeons' practice, medical institutions should provide support to surgeons. Future research is needed to confirm whether legal counsel may prevent defensive medicine. (C) 2015 Elsevier Inc. All rights reserved.