Bouncebacks! Medical and Legal is a thought-provoking book engaging a synoptic view of the intersection between law and medicine. The practice of law and the practice of medicine are inextricably intertwined; still, their respective methods of analysis suffer from a logical disconnect. The medical world uses retrospective review of care for the purpose of quality improvement—ie, to learn from prior outcomes and improve care in the future. Legal analysis seeks to evaluate the root cause of a problem, not for the purpose of quality improvement, but to redress perceived wrongs that have befallen the patient. Bouncebacks! addresses this issue head on through analysis of emergency department case studies.
The text opens and closes with a brief discussion of how a lawsuit works. Although the descriptions given are simplistic, they provide an overview of the process, the players, and the general time frame involved in medical malpractice litigation. For physicians fortunate enough to not have any personal experience in the courtroom, it is a primer on how the process works. It is not overburdened with legal vernacular but provides basic information that most physicians would find helpful.
The vast majority of the text is developed through case studies that provide in-depth analysis of 10 different emergency department presentations. Although this is not atypical of a book discussing emergency medicine, Bouncebacks! provides not only the medical analysis but also a multifactorial view of individual patient presentations. The authors astutely recognize that medical malpractice cases are rarely generated from the obvious presentation. Myocardial infarctions occurring in patients who present with classic signs and symptoms of an acute coronary syndrome are rarely missed. Patients who present atypically or who have commonly seen symptoms with uncommonly dangerous ramifications are the ones who tend to fall through the cracks. The case studies focus on subtle presentations of life-threatening illnesses.
Each case study contains references to (and sometimes scans of) the most important portions of the medical records to provide background and substance. The most intriguing aspects are the additional perspectives used in evaluating each case study. The authors bring in the perspectives of not only the physician caring for the patient but of other players in medical litigation. The authors use testimonial clips of key witnesses, including the plaintiffs and the defendant physicians, to provide context for the legal analysis. Each case study provides insight from the plaintiff ‘s and the defendant’s attorneys. This is accomplished through interviews with the attorneys and, in some cases, paraphrasing of opening statements and closing arguments. The perspective of the attorneys actually trying the case provides depth to the analysis of how the case may be perceived by a jury and not just how it will play out in a morbidity and mortality conference. Testimonial summaries illustrate the emotional pleas of plaintiffs and the factual medical analysis of the defendants—the stark contrast seen in nearly all medical malpractice litigation.
Medical malpractice claims typically turn on the testimony of expert witnesses. The authors of Bouncebacks!provide an objective analysis of the interplay between experts on both sides of each case. Along with the experts engaged by the parties in the case, the authors also call on other experienced emergency department physicians and malpractice attorneys to provide additional analysis of the care provided and the potential pitfalls at trial. Critical analysis is made of the risk factors for each patient and how the emergency department physician documented the patient’s presentation and differential diagnosis.
Last, the authors evaluate the overall care provided to the patient in the emergency department from several perspectives. The authors provide takeaway points for physicians to consider in balancing good medicine with risk avoidance. In most medical malpractice cases, good documentation and communication are an integral part of that discussion. The authors reveal the actual outcome of the litigation but independently analyze whether, in their opinion, the case should have been settled or tried by a jury—weighing the risk of an adverse verdict; the quality of experts; the dynamics of interplay between physicians, attorneys, and insurance companies; and the potential for sympathy and a runaway verdict.
Bouncebacks! Medical and Legal is an insightful and pragmatic analysis of emergency department malpractice litigation. The authors provide the reader with interpretive perspectives from all sides of patient care—the holistic view ultimately evaluated by a jury. The lessons presented are a good reminder for any practicing physician.
Randall S. Hanson, JD
The Journal of the American Medical Association (JAMA)
JAMA. 2012;308(6):626-626. doi:10.1001/jama.308.6.626
