Legal Issues

Abstract

Legal policy and patient safety efforts are opposing forces when the legal climate that physicians practice in damages their well-being in ways that lead to less optimal clinical care. Threat of litigation may also adversely affect patient safety when clinicians’ fears of adversarial legal action lead them to practice of defensive rather than evidence-based medicine. In order to “win” negligence lawsuits, patient plaintiffs must satisfy the burden of proof for four elements, namely, duty, breach, causation, and damages. If the burden of proof is not satisfied for any one of these, a legal process will not render a negligence judgment against the physician. However, it is the process of the lawsuit itself—independent of outcome—that may render the largest substantive risk to physicians in terms of well-being, reputation, loss of time, and cost of defending a case. Most physicians are named in a lawsuit one or more times during their careers. Malpractice insurance typically covers the added—and less common—financial burden of losing a case. In addition to threat of lawsuit, physicians may be subject to investigation and disciplinary actions by their state medical board. Risk management efforts unify the goals of mitigating the risk of a lawsuit and improving patient safety. Current literature does not yet clarify the effects of policy limiting resident work hours on patient safety. Most physicians suffer significant emotional distress when they are part of a medical error. Peer support efforts may improve risk management by supporting the well-being of physicians after adverse clinical events.