Assume your place in the pillory. Everything that you've done is viewed in the worst possible light. Your motives are the lowest, your tactics despicable, your incompetence beyond dispute.

This is not the latest offering from Fox Television. It is the position in which many surgeons find themselves while defending a malpractice suit.

In one courtroom, an inventive plaintiff's attorney characterizes a LASIK defendant's 10-minute turnaround on surgeries as sounding like scheduling tee-times at the country club. Another likes to stand before the jury holding a blurred picture of a gray-haired mother to illustrate the state of his client's vision.

Most surgeons who endure this kind of treatment come through with their commitment to good patient care, if not their faith in the legal system, intact. Clearly, though, the best defense is prevention. At the risk of oversimplification, in most cases, the surgeon is still in control of that.

According to the Federation of State Medical Boards, "A large body of literature spanning more than 40 years has shown quite convincingly that poor communication, interpersonal and general clinical skills are related to a higher incidence of malpractice suits, lower treatment compliance and decreased patient satisfaction."1

Joseph S. Alpert, MD, of the University of Arizona College of Medicine, writing last month in the Archives of Internal Medicine, offered some sage advice, not intended specifically for malpractice avoidance, but as a general approach to medical practice.2

Dr. Alpert wrote, " … a 10-minute patient-physician encounter markedly decreases the opportunity to invoke the beneficial therapeutic component that develops with a longer interaction. Very short encounters frequently leave patients with a sense that the physician is not really interested in their well-being."

Of obtaining informed consent, he said, "The negative aspects of obtaining informed consent involve the recitation of potential complications in a blunt and uncaring style that terrifies the patient.  … performed in this manner, the process can be a truly frightening experience for the patient … Imagine how the average person, about to buy a new car, might feel if confronted with a long list of potential outcomes from traffic accidents (death, dismemberment, paraplegia, quadriplegia, etc.) at the time of purchase."

That malpractice suits are an unavoidable fact of life needn't consign you to practicing with your head in the pillory. The good news is that, in most cases, you still hold the key to avoiding it.

—Chris Glenn, Editor in Chief

1. Position of the Federation of State Medical Boards. In Support of Adding a Clinical Skills Examination Using Standardized Patients to the United States Medical Licensing.
2. Alpert J. Advice for Young Physicians. Archives of Internal Medicine January 13, 2003;163:12.