'No surgery is without risk': Spine surgeons aim to limit exposure

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Spine surgery, like all other specialties, carries risks for both patients and physicians. However, physician-patient communication is crucial to limiting risk.

Eighty-two percent of orthopedic surgeons surveyed by Medscape have been named in malpractice lawsuits, and the specialty is the second most likely to be named in litigation, according to a report.

Common causes for malpractice lawsuits overall include failures or delays in diagnoses, but in some cases, a surgical complication can lead to patients taking legal action against spine and orthopedic surgeons.

Two spine surgeons shared with Becker's how they handle surgical complications and communicating risks with patients.

Note: Responses were lightly edited for clarity and length.

Lali Sekhon, MD, PhD. Reno (Nev.) Orthopedic Center: As surgeons, we are here to help patients. The training is long. We are dedicated to helping our patients. No surgery is without risk. Some carry considerable risk. Every surgeon covers risks, benefits and alternatives, but bad things can happen. Sometimes they are minor. Sometimes not. Again, as surgeons, we strive to fix this as best we can. I discuss risk with my patients. I give them handouts delineating the risks discussed. I email them more information. They have access to my notes through the EMR patient portal. I spend at least 30 minutes with every surgical patient, and coming to surgery can often take two or more visits. At the end of the day, the strategies are: I have direct conversations with families about "speed bumps" (minor complications) and "stop signs" (catastrophic complications). I get my share of complications, as does every surgeon, but I educate my patients preoperatively and actively engage directly (not a PA/NP or resident) if there are problems. 

Tort reform is something actively chased by trial attorneys. It recently happened in my state to the detriment of physicians. What does increased litigation mean? Medicine becomes more unattractive when coupled with reduced reimbursement, bureaucratic loads and added increased threat of litigation. High-risk surgeries may be avoided or referred. Patients may not get the interventions they need. At the end of the day, increased litigation benefits a few but is to the detriment of many. 

 

Michael Venezia, DO. Orthopedic Specialties of Tampa Bay (Clearwater, Fla.): I think this really comes down to two separate things that need to be addressed. I try to spend time with my surgical patients and make sure that they understand the risks. I think it's important to break it down for them to where they can understand them and why we discuss them, as well as how common (or uncommon) they are. I also like to discuss the "what if" situations so they understand what a complication looks like after the fact. Then unfortunately the other important part is the consent and making sure that it covers all the basis of that said procedure. I truly think that most consents are written for medicolegal purpose and we don't do a great job of making them user friendly, which is why I think the in-office discussion is so important. 

I think we could unfortunately find ourselves in a situation where the higher acuity and risk patients get pushed towards a more protected university setting. This hurts access to care, as there are only so many patients that can be seen and helped in a day. It's unfortunate for surgeons like myself who enjoy taking on complex patients, but are faced with increased litigation exposure risk in a private practice setting. As a "privademics" surgeon, I also train residents who, for the good of their education, need to see complex patients in their training. This creates a conundrum, as we have to balance the good of education with risk mitigation in our personal life.  

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