1358. A Den of Vipers – Malpractice and Its Profound Threat to Resilience

Authors: Gary Robert Simonds, MD, FAANS; Gary Simonds; Chris Busch; Michael Benko; Zev Elias, MD; Wayne Sotile, PhD (Black Mountain, NC)


We are concerned about the risk of burnout imposed by malpractice litigation and its attendant machinations. We have studied the response of residents to simulated malpractice depositions to isolate commonalities in negative responses.


We routinely engage our residents in role-playing exercises related to malpractice litigation. Actual cases with associated complications or bad outcomes are employed. Cases selection is personalized to the resident (patients in whose care they were intimately involved). A one-hour deposition is then conducted with litigation-experienced neurosurgeons leading the plaintiff’s examination. The mock deposition is conducted before the entire team who are solicited for commentary only after the experience. The involved resident is then interviewed after the session. Paper and pencil surveys of the entire team are conducted.


Participating residents report profound physiological and emotional reactions to the experience (as do the spectators). Most common associated experiences include: tightness in the chest, sweating, palpitations, cognitive blurring, confusion, loss of memory; as well as a sense of violation, injustice, loss of control, assault on identity, guilt, sadness, incompetence, vulnerability, anxiety, grief, imposter syndrome, defenseless, frustration, and anger. Residents reported that the experience gave them pause for thought about the scope and location of their future practices.


Malpractice litigation is an assault on a neurosurgeon's resilience and can profoundly impact the conduct of their future careers. We believe that the physiological and emotional responses of neurosurgeons to the ordeal should be further studied and that methods for mitigating the negative responses should be evaluated and practiced. We will discuss methods such as problem-focused coping and emotion-focused coping in this presentation, as well as other practical methods of limiting both legal and emotional damage.