Preventing Medicolegal Problems in Neurosurgical Practice: Do's and Don'ts

There is a sea change in the scenario of medical practice, manifested in a serious trust deficit between patients and doctors and an exponential rise in malpractice litigation. This has given boost to the practice of defensive medicine by doctors. Neurosurgery is considered to be a high-risk branch of surgery in terms of potential for medicolegal issues. It is inevitable that as a response to these changes, we should identify the potential problem areas and adopt measures to deal with them. Practicing ethical, rational, and evidence-based medicine can minimize medicolegal problems. It is suggested to avoid treating patients beyond one's competence. In this review, the concept of negligence is defined, and the common allegations and causes of litigation in neurosurgical practice are identified. The importance of keeping meticulous patient records in preventing medicolegal problems is emphasized. The value of obtaining informed consent and operation-specific consent is highlighted. It is advised not to overpromise the results of treatment. The roles of effective communication and display of empathy toward treated individuals are important factors in averting litigation by them. Communication failure results in breakdown of the doctor-patient relationship. The protective value of professional liability insurance to deal with potential problems is stressed. Finally, the practice of "jousting," or bad-mouthing a colleague, is strongly condemned, as it can provoke malpractice litigation.