Trauma is referred to as the injuries individuals obtain when they have been hit by force. This can be due to crashes, fights, accidents and even falls. Trauma surgery is highly specialized and requires swift and agile thinking and action. But these are not the only criteria a physician utilizes to base his decision on whether to move into a fellowship for trauma and surgical care. For a long time now, the publicity of medico-legal claims has made their way into influencing the career path of a newly hatched medical resident.
A study conducted by McGwin et al, in 2007, looked into exactly what was the impact of these lawsuits when opting for specialization in trauma, whether there was any basis to it and what are some of the effects of such a skewed view. For this 13 medical and surgical specialities were considered. There were a total of 194 events. 183,392 patients were seen and accumulated 757,880 days of hospitalization as a whole. It was found that Trauma actually had less than 1.05 events and lawsuits filed per 10,000 patient days. This was reported to be way less than the figures stated for general surgery, orthopaedic or plastic surgery. In fact, the latter three domains of surgery demonstrated a higher rate of incidence and gravity of such events regardless of whether they were measures per patient days or per patients.
However, medico-legal claims are not the sole negative gauge on which physicians base their decisions for career paths. Other factors to consider were the type of medical school (public vs. private), lifestyle, prestige, income, planned practice location (rural vs. urban). This also renders some areas less preferred for certain medical specialities leaving them under-resourced.
Another similar study carried out in a French teaching hospital for a period of ten years has revealed that the cost of medico-legal claims over the years has steadily been increasing, although at a snail’s pace. Out of a total of 51,582 surgical procedures carried out in the hospital, the number of lawsuits that incurred payment was 29 which is 0.0005%. Over the years in America and Europe, not just the number of claimants but the cost of damages has also been rising. An interesting fact to note is that surgeries involving the lower limbs garner more in damages than the upper limbs. Moreover, nosocomial infections hold the record for being the most popular cause for litigations (~50%). Therefore, it can be beneficial to inform the patient beforehand of the possible chances of infection post-op.
Trauma and orthopaedic surgeons serving as a specialist to review lawsuits have recently become more reliable with the use of covert surveillance systems. These allow for a more comprehensive and verifiable decision especially when the symptoms can be completely subjective such as pain. Two such case studies will be discussed.
Mr Jan slipped and fell hard on an icy surface while exiting a company vehicle. It left him with ongoing pain and a limp. In surveillance footage taken after the incident, Mr Jan was seen on a number of occasions walking, pushing a wheelie bin to the kerb, taking public transport and driving, and even gardening and erecting a fence.
There was no such equivalent surveillance footage demonstrating this. Therefore, in my opinion, a conclusion against the claimant could not be drawn because the evidence did not have any relevance to the particular debility the claimant experienced as a result of his accident.
In another situation, Ms May slipped on a wet floor at the races and in the process injured her left arm while trying to break the fall. The pain and swelling required a trip to the hospital and an X-ray revealed a fracture. She spent a number of days in the hospital and received physiotherapy after being discharged.
As Ms May’s pain did not seem to diminish and made day-to-day tasks extremely difficult, she was further diagnosed with neuropathic pain. In her witness statement, she said her left hand was, as a result, almost non-functional. This was supported by the expert clinician who examined her.
However, the surveillance footage I was asked to opine on revealed Ms May performing everyday tasks without any sign of struggle. The footage showed her driving, carrying shopping bags, swapping them from one hand to the other while attending to her hair, managing payment dexterously using both hands, and pushing and pulling doors to enter stores – without any discernible abnormalities.
I had to logically conclude after reviewing the surveillance footage that there was no evidence of pain, disability, restriction of movement or other abnormalities regarding Ms May’s left upper limb. Ms May lost her claim.
In conclusion, the field of orthopaedic and trauma surgery brings with it more or less the same amount of risk that is found in a lot of other similar lines of professions. Working in the domain requires a certain aptitude and thinking skill set that is able to cope under pressure but also make sound judgements.