[Prevention and management of the conflict patient-doctor]

A surgeon's daily practice evolves according to techniques, but also according to a legal and associative environment. The patient is becoming a health consumer, demanding and informed, legitimately exacting security and transparency, but also compensation in the event of accidental injury. The constraints that weigh upon this profession are growing heavier: knowledge and respect of laws, ordinances and regulations are becoming essential and law suits more and more frequent. Ever present in surgery, risk evaluation and assessing the risk-benefit ratio for the patient must be clearly stated by the practitioner and his team, despite the inherent difficulties in sharing information. A classification of surgical risk facilitates an approach to the definitions of a fault, medical accident, iatrogenic condition or undesirable event. This is a fundamental concept, since precise criteria apply to a fault in the legal sense, whereas no normative definition exists for a medical fault. Prevention of conflict requires the implementation of collective steps aimed at ensuring security in a complex system, confidence between the surgeon and his patient based on appropriate information and strict adherence to current regulations. In the event of complications, difficult after-effects, objectively unsatisfactory results or those perceived as such by the patient, post-operative follow-up must face these difficulties squarely with transparency and responsibility. Following a legal summons involving the responsibility of the practitioner, management of the conflict between the physician and the patient requires solid preparation of the medical file and his active participation in the judicial expertise so as to best inform the judge.