Practicing Medicine in Today's Legal Climate

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Dr. Paul Indman:  “This is Dr. Paul Indman from the National Congress of Gynecologic Endoscopy in Cancun, and I’m pleased to have with me Dr. Richard Soderstrom.  Dr. Soderstrom is an expert in gynecologic endoscopy and has special expertise in the medical/legal aspects of endoscopy.  Dick, I have one question for you.  Do you feel that the legal climate has hampered or slowed down developments in medicine; are people afraid to do things because of the legal questions?”

Dr. Richard Soderstrom:  “I would say it’s actually probably the opposite.  People are sometimes trying to do too much so that it covered too many bases at one time rather than just getting in and doing what they went there to do.  For instance, someone does a laparoscopic procedure looking for right lower quadrant pain and they find the cause of the right lower quadrant pain but while they’re there they find some other disease process that has nothing to do with the patient’s complaints such as adhesions that were asymptomatic.  They start lysing these adhesions and get into bleeding or injure an adjacent structure.  I don’t think those are things that are keeping people from doing things; it’s actually going beyond what the purpose of the operation was.  What I’m seeing in the medical/legal area is problems associated with laparoscopic assisted vaginal hysterectomies where the individual’s indications are perhaps suspect, the procedure has difficulty, and then the post-operative period is not surveyed closely enough by the operating physician.  Ureteral injuries are substantially higher than expected with this operation, and yet there seems to be little attention to checking for possible injury at least when medical/legal questions are raised.  The other frequent cause of injury as it relates to medical/legal causes of investigation is injury to the great major vessels, which is for the most part preventible if one follows standard techniques.  Again, I don’t think this has anything to do with preventing advancement, it’s simply remembering some of the basics that are associated with laparoscopic techniques and methods.”

Dr. Paul Indman:  “Dick, one question I frequently get asked is the advisability of videotaping surgical procedures.”

Dr. Richard Soderstrom:  “It is not standard to do videotaping of all surgical procedures.  In my circumstance, I generally use it only when I’m making an educational film, which may at times be educational for the patient, such as a patient who has chronic pelvic pain of unknown origin.  We videotape it, give it to them, and after they’ve come back for their follow-up examination when everything is healed up, then we go over the videotape.  The problem with routinely videotaping is there’s a storage problem and if a medical/legal question is entertained and there’s no videotape found yet a videotape was taken, the surgeon is then suspect of a possible spoilage of evidence as it’s called.  The videotape that shows a mistake obviously is going to be a problem.  On the converse if, say, a tubal sterilization is done properly, videotaped, and is recorded and then there’s a failure later, it certainly would be a good defense.  I think it’s a matter of dedication to videotaping, if one is truly going to do that, they’re going to have to prevent the roadblocks from occurring and making sure that storage is available.  Of course, if you start to edit a videotape, then you’re really in trouble if something goes wrong and there’s nothing to explain it on the videotape, it is then declared by the attorneys as some type of spoilage of evidence.  As I said, we use it in our institution mainly now for educational purposes.  To my knowledge, it’s not been declared as standard to use videotape routinely.”

Dr. Paul Indman:  “Dick, I think that’s very helpful.  I think it’s really disappointing that we can’t routinely videotape procedures without fear of litigation because I can’t think of a better teaching tool.  It would be nice just like the black boxes and the flight recorders to be able to have information to review anytime there’s a problem and learn from that without the fear of litigation.  So I think that’s a very helpful answer to a very difficult question.  Thank you very much.”