Comments or questions? We have about 10 minutes for discussion. I have a very minimal malpractice exposure, thank goodness, but what I have learned, and I think it's been touched on in different ways about communication, never piss off a mother. I mean, even if you've got a bad outcome, if you don't supply enough empathy and really think about every day you're on rounds, you sit down in a room with these people, you don't, you know, there may be difficult people and the child may be having a really bad problem and your instinct will tell you, get in there, hey, everything going all right, fine, get out, never do that. Sit down, look them in the eye, empathize, and never piss off mom, because a lot of times these lawsuits are just punitive. They are mad at you. It's not so much they're mad at the overall outcome, but they're mad at the way they perceive that you treated them, so be sweet. Yeah. I'm a young pediatric neurosurgeon from China, from Shanghai, and very happy to saw two previous professors to discuss their practice and they share their precious experience. I just do some comment, some of these kind of cases in China. In China, we have didn't get this kind of full practice or full system to protect doctors. If our doctors got a lawsuit, got some implications, so we first try to communicate with parents and families, but sometimes parents and families are insane. They cannot understand. They can occupy your office, can corrupt your normal disorders. Sometimes, you may see on the website or on the news, several hundred Chinese doctors have been killed by a patient. So nowadays, the environment of our practice is totally unsafe in China. Yeah, really can cause this type of problem. So sometimes when you really do a difficult case, the first thought, for example, in the OR, we got the artery bleeding and maybe got the first time we thought we try to rescue, try to save the case as much as I can, but another thought come to you that the patient maybe maybe got, maybe get discomfort or got insult, body insult by the parents. So sometimes, yes, very difficult. Thanks for your wonderful experience. Thank you. Yeah, Dr. Wissoff, and thank you very much for speaking on this topic. I have a question, which is I've looked back in the literature a little bit about the emotional impact of these lawsuits, and they've been likened to a death in the family or a divorce sort of thing. And what sort of information can you give us or advice about how to deal with that sort of emotional toll? I think it's like Kubler-Ross. It's multiple levels. I think any time you receive the summons, the notification that you're being sued, it's a kick in the groin. You know, most of the time, you don't expect it, because most of the time, you think this was awful, but I've had so many other awful experiences. You know, people have been hurt, and yet people get better. So most of the time, you don't expect it. The next phase is you want to tell everyone in the world about it and beat your breast, and that's absolutely the worst thing. The last thing you ever want to do is discuss this with anyone else, because anyone besides your attorney that you discuss this with, or the QA people, can be ultimately called on to testify what you said. So you do have to be a little protective at that point. Then you go through this process of what's known as discovery, where all your records are reviewed if they haven't been already, and then you get to sit down for a deposition where, over a series of hours, a very businesslike attorney asks you questions that are searing your soul, because, again, to you, this isn't business. This is an emotional assault on what you've done. And then, finally, you get to trial, and at trial, you realize it's all theater. At least you try to realize that. How do you deal with it personally? I've never known how to offload the emotional impact of when I get the summons, other than having a scotch. The depositions, I try to intellectualize it as much as I can. I want to be accurate. I want to tell them what they need to know, but you also have to avoid the tendency to explain everything. The job of the deposition is not for you to offer either a mea culpa or your explanation. It's simply to recite facts. And then, at trial, it's your opportunity, if you get to trial, to bare your soul and explain why you did what you did. You have to understand the lawyers don't inherently hate you, most of the time. The families might, but the lawyers don't. To them, it's a business. It's a way of achieving compensation for themselves and their clients. And I think if you can intellectualize a bit, it helps, rather than just making everyone angels and devils. I don't know. Mike, do you have any words of wisdom? Just the only other comment is, I think it's the cost of doing business, as I said. I mean, I think we all have to understand that it's taken me a long time to come to that conclusion. A couple of points. On that same subject, I think the answer is, you actually don't ever forget it. It's like a patient dying. I think you wake up always one morning a month or one morning a week and think, could I really have done anything else? Was it really my fault? Regardless, regardless of the outcome of the suit. And I think you just have to, every day, just get on with what you're doing. What I did want to say also was that one of the issues that I noticed with our residents and young staff as well is the whole question of, what is informed consent? And what I note is the list of potential disasters gets longer and longer every single year. And I had a colleague who put in that the OR light might fall out of the ceiling as well, because that had happened once. I think the way I had, and we're dealing with not the patient, obviously. We're dealing with the parents who have to tell us it's OK for us to operate on their most precious thing, their kids. And so, and I certainly have colleagues still who absolutely will sit down and talk about every conceivable bad result they can imagine, often to the point where the parent may want to go to somebody else. And I think, yes, you have to be honest. But what I've tended to do is go over the things that can happen and then say, but you know, these are unlikely. And here are the things I'm worried about. If I'm going to do a craniopharyngioma, your child's going to have a third nerve palsy afterwards. It's going to go away. Rather than, they're going to be paralyzed for the rest of life. They're going to be idiots. They're going to get fat as hell. I mean, all the other. So I think you can put in all the things you need to say. And often the residents will do that for you in the five lines of it. But when you sit down with the family to make sure that they understand you care, and they understand and worry about the things that you know have a high likelihood of happening, rather than just terrify them out of their minds. Because, you know, I talked about this the other day. But for the parents as well, if you make them desperately frightened about the surgery, that goes over to the kid. And I don't think that's the best situation. I hope when I put up the examples of what I thought informed consent would be, to me, informed consent is education. What we do with our families, our kids, all the time. This is the way I do it. I would agree 100% with Derek. You don't want a laundry list. You don't want to scare the devil out of the family. So that, you know, there's one famous neurologist in New York, who every time he saw a child with a headache, would make the family think that more likely than not, this is a malignant brain tumor. I'm going to go all through this diagnostic test. And what turns out to be migraines, they thought he was a genius. You don't want to hang so much black crepe and make them go into mourning that after an operation that has a 99% chance of success, they hail you as a deity. On the other hand, I do think just as you do the education, you want to at least document a modicum of the education you're doing. And I think that helps. And I think that's pretty much congruent with what you're saying, Derek. I guess this is for either Dr. Scott or Dr. Wisshoff. I'm curious, you've talked about, Dr. Wisshoff mentioned, once you have the complication, you have that period of time where you want to talk to everybody about it. And the statement that you want to try to limit that. But I'm curious how you apply that to the family. Because you often have this dichotomy between law and medicine, where the law says, don't admit guilt. But medicine says, you want to do the best for your patient. And I think back to Dr. Scott's lecture about, it's always about the patient, not about ego. So I'm curious how you put those things together when disclosing what happened to the family. I think this is probably very difficult for all of us who are thinking specifically about admitting an error. I mean, our lawyers, and my own feeling is that we always have to be completely honest with the families and to tell them exactly what happened. There's going to be, I mean, there are many, many, many reasons for doing that. The most self-serving of which is that that fact is going to be discovered sooner or later if there's been an error or something's happened in the operating room that shouldn't have happened. I mean, I always believe in telling the families exactly what happened and being honest with them from the very beginning. And I think that's just the right thing to do. But the lawyers, I think, at the hospital and our malpractice insurer tell us that that is the right thing to do. And I think more and more people are saying, you know, this happened. I'm sorry. We're going to do our very best to do the best we can for your child. Yeah, I agree completely. But when I said don't discuss, that's when a lawsuit's initiated, when you get summons. That's not the time to then try to understand by consulting widely with your colleagues, the dietician, the receptionist, what you did wrong. I think you always want to tell the family what's going on. The child who died, I didn't know the full sequence of events when I got there that night. And I sat down with the family afterwards. And I said, I'm sorry. I don't know why your child died. And we'll find out. And I will be certain that you know. And when I knew, the answer was it was indefensible. Thank you to both of you. I think we're going to move on to the abstract portion of this session.

communication

empathy

lawsuits

informed consent

admitting mistakes