Medical malpractice and anesthesiology: literature review and role of the expert witness.
OBJECTIVE
To provide a narrative review of the physician experience of medical malpractice litigation applied to an anesthesiology case with particular emphasis on the role played by medical expert witnesses.


METHODS
Literature searches were conducted of English-language medical publications published between 1996 - 2006 using both Medline and Pubmed databases. Key words included: "medical malpractice"; "medical malpractice litigation"; "medical expert witness"; "expert witness liability", "expert witness bias"; "hindsight bias"; and "outcome bias".


RESULTS
Patient injury resulting from medical care is common but most injured patients do not sue. Implicit review of medical files is biased to an important degree by the occurrence of severe injury; care is more often deemed substandard when the resulting injury is severe. Expert analysis of medical mal-occurrences is influenced by both hindsight and outcome bias. Compensation for those who do sue is influenced by the severity of injury and the degree of disability. The activity of experts is not commonly subject to review by peers, professional groups or licensing authorities.


CONCLUSIONS
The legal process for resolving patient claims against physicians is well delineated and transparent; its operational features are complex and prejudiced by severe outcomes. Bias is pervasive in the analysis of medical occurrences and may result in findings against caregivers which are unfair.
Crosby
Edward
E
Department of Anesthesiology, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. ecrosby@sympatico.ca
D000776:Anesthesiology / Q000331:legislation & jurisprudence* / Q000592:standards; D002170:Canada; D005104:Expert Testimony / Q000331:legislation & jurisprudence* / Q000592:standards; D006801:Humans; D008318:Malpractice / Q000331:legislation & jurisprudence*; D015588:Observer Variation; D017410:Practice Guidelines as Topic / Q000592:standards; D011787:Quality of Health Care / Q000331:legislation & jurisprudence* / Q000592:standards