Virtually all neurosurgeons will have to deal with a medicolegal issue by the end of their career. Neurosurgeons have the highest annualized rate of lawsuits at >19%. Perhaps shockingly, even by age 45, approximately 88% of surgeons in high-risk subspecialties will have been involved in a lawsuit. This number elevates to >99% by age 65. The concern about professional liability lawsuits is, without a doubt, the highest profile medicolegal issue for neurosurgeons — even though many more issues other than litigation affect our daily medical practices. Medicolegal and socioeconomic topics such as neurosurgical workforce, contracting and employment, and payor/insurance issues such as coverage policies, reimbursement and prior authorization regularly impact each neurosurgeon’s practice in multiple ways — even if it is not immediately apparent.
We are all trained in both the science and art of medicine throughout those seven long years of residency. Yet, historically, very little attention is paid to educating neurosurgeons about myriad medicolegal and socioeconomic issues. There is a relative dearth of information on socioeconomic topics compared to matters concerning the science and practice of medicine in the literature. As such, during our residency and in our daily practice, we learn precious little about issues related to the social, political or economic aspects of neurosurgery. However, these issues consume so much of our time and significantly impact our practices.
To this end, the November issue of Neurosurgical Focus is dedicated to medicolegal issues that can be useful to neurosurgeons at all stages of practice. We hope that this issue will serve as a primer on the subject so that neurosurgeons can develop an appetite for regular reading about and involvement with these critical issues.
Articles in the Neurosurgical Focus’ November issue include:
- The importance of understanding the medicolegal climate in neurosurgery
- Overview of medical malpractice in neurosurgery
- Experiences of neurological surgeons with malpractice lawsuits
- What doesn’t kill you makes you stronger
- Status of current medicolegal reform in the United States: a neurosurgical perspective
- Informed consent in neurosurgery: a systematic review
- The changing landscape of military medical malpractice: from the Feres Doctrine to present
- Examining the Emergency Medical Treatment and Active Labor Act: impact on telemedicine for neurotrauma
- Disciplinary law and neurosurgery: a 10-year analysis of cases in the Netherlands
- Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits
- Litigations following spinal neurosurgery in France: ‘out-of-court system,’ therapeutic hazard, and welfare state
- Out-of-court system: a fair fast track to savings of time and money
- Malpractice and socioeconomic aspects in neurosurgery: a developing-country reality
- The ethical and legal status of neurosurgical guidelines: the neurosurgeon’s golden fleece or Achilles’ heel?
- Sovereign immunity and its implications for neurosurgery
- Medical malpractice in spine surgery: a review
- Litigation risks despite guideline adherence for acute spinal cord injury: time is spine
- Does state malpractice environment affect outcomes following spinal fusions? A robust statistical and machine learning analysis of 549,775 discharges following spinal fusion surgery in the United States
- Damned if you monitor, damned if you don’t: medical malpractice and intraoperative neuromonitoring for spinal surgery
- The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States
- Determinants of brain tumor malpractice litigation outcome and indemnity payments: a 29-year nationwide analysis
- Medical malpractice and meningiomas: an analysis of 47 cases
- Medicolegal issues in abusive head trauma for the pediatric neurosurgeon
Lastly, please note the hard work in this area that the Council of State Neurosurgical Societies (CSNS) has done for decades. The CSNS is the group in organized neurosurgery that addresses the confluence of medicolegal and socioeconomic issues and neurosurgical practice as neurosurgeons. It is jointly supported by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons since its inception in 1972. It began as the Joint Socio-Economics Committee. It functions as a grassroots organization whose members are drawn from each state’s neurosurgical society. This structure allows it to be broadly representative of the whole of neurosurgery while at the same time being agile enough to deal with the rapidly changing landscape of these issues. In addition to delving into the November medicolegal issue of Neurosurgical Focus, neurosurgeons are encouraged to participate as active members in your state neurosurgical society to ensure that you remain an integral part of the CSNS.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and @CouncilSNS and using the hashtag #Medicolegal.
Jason D. Stacy, MD
North Mississippi Medical Center