Impact of Malpractice Liability Among Spine Surgeons: A National Survey of French Private Neurosurgeons

Journal Pre-proof
Impact of Malpractice Liability Among Spine Surgeons: A National
Survey of French Private Neurosurgeons
Bertrand Debono MD Olivier Hamel MD PhD Antoine Guillain Anne
Durand MD PhD Marjory Ru ´ e MD Pascal Sabatier MD Guillaume
Lonjon MD PhD Gregory Dran MD, on behalf of French Society of
Private Neurosurgeons (SFNCL)
PII: S0028-3770(20)30334-9
DOI: https://doi.org/doi:10.1016/j.neuchi.2020.05.003
Reference: NEUCHI 1092
To appear in: Neurochirurgie
Received Date: 8 January 2020
Revised Date: 3 April 2020
Accepted Date: 2 May 2020
Please cite this article as: Debono B, Hamel O, Guillain A, Durand A, Ru´ e M, Sabatier P,
Lonjon G, Dran G, Impact of Malpractice Liability Among Spine Surgeons: A National Survey
of French Private Neurosurgeons, Neurochirurgie (2020),
doi: https://doi.org/10.1016/j.neuchi.2020.05.003
This is a PDF file of an article that has undergone enhancements after acceptance, such as
the addition of a cover page and metadata, and formatting for readability, but it is not yet the
definitive version of record. This version will undergo additional copyediting, typesetting and
review before it is published in its final form, but we are providing this version to give early
visibility of the article. Please note that, during the production process, errors may be
discovered which could affect the content, and all legal disclaimers that apply to the journal
pertain.
© 2020 Published by Elsevier.

Page 1 of 19
Journal Pre-proof
Impact of Malpractice Liability Among Spine Surgeons: A National
Survey of French Private Neurosurgeons
Impact de la judiciarisation de la pratique chirurgicale : Une enquête nationale
auprès des neurochirurgiens libéraux français
Bertrand Debono, MD1, Olivier Hamel, MD, PhD1, Antoine Guillain2,3, Anne Durand, MD, PhD4,
Marjory Rué, MD5, Pascal Sabatier, MD1, Guillaume Lonjon, MD, PhD6, Gregory Dran, MD7 on behalf
of French Society of Private Neurosurgeons (SFNCL)
1 Ramsay-Clinique des Cèdres, Neurosurgery, Cornebarrieu, France
2 Sorbonne Study Group on Methods of Sociological Analysis of the Sorbonne (GEMASS), Sorbonne
University, Paris, France
3 SiRIC CURAMUS (Integrated cancer research site), Assistance Publique-Hôpitaux de Paris, Sorbonne
University, Paris, France
4 Infirmerie Protestante, Neurosurgery, Caluire, France
5 Endoscopic Spine Center, Bordeaux, France
6 Orthosud, Spine Surgery Department, Montpellier, France
7 Clinique du millénaire, Neurosurgery, Montpellier, France
Corresponding author
Bertrand Debono, MD
Department of Neurosurgery, Neuroscience Pole
Ramsay – Clinique des Cèdres
31700 Cornebarrieu
France
[phone]
[phone]
[e-mail]
orcid.org/0000-0003-4638-1075
The authors report no conflict of interest. The manuscript submitted does not contain information about
medical device(s)/drug(s). No funds were received in support of this work.
Original Article in English

Page 2 of 19
Journal Pre-proof
Impact of Malpractice Liability Among Spine Surgeons: A National
Survey of French Private Neurosurgeons
Impact de la judiciarisation de la pratique chirurgicale : Une enquête nationale
auprès des neurochirurgiens libéraux français
The authors report no conflict of interest. The manuscript submitted does not contain information about
medical device(s)/drug(s). No funds were received in support of this work.

Page 3 of 19
Journal Pre-proof
Abstract in English
Purpose
In the general context of medical judicialization, spine surgeons are impacted by the part that medical
responsibility and the risk of malpractice play in their actions and decisions. Our aim was to evaluate
possible shifts in practices among private neurosurgeons who are highly exposed to this judicial risk and
detect alterations in their pleasure in exercising their profession. We present the first national survey on
French physicians’ perception of surgical judicialization and consequences on their practice.
Methods
An online survey was submitted to the 121 members of the French Society of Private Neurosurgery,
who represent 29.1% of the total number of spine surgeons and perform 36.0% of the national total spine
surgery activity. The French law (no-fault out-of-court scheme) significantly impacts these surgeons in
the event of litigation.
Results
A total of 78 surveys were completed (64.5% response rate): 89.7% of respondents experienced
alteration of doctor-patient relationship related to judicialization and 60.2% had already refused to
perform risky surgeries. Fear of being sued added negative pressure during surgery for 55.1% of
respondents and 37.2% of them had already considered stopping their practice because of this litigation
context.
Conclusion
The increasing impact of medical liability is prompting practitioners to change their practice and
perceptions. The doctor-patient relationship appears to be altered, negative pressure is placed on
physicians and defensively, some neurosurgeons may refuse high-risk patients and procedures. This
situation causes professional disenchantment and can ultimately prove disadvantageous for both doctors
and patients.
Abstract en français
Introduction
Dans le contexte général de la judiciarisation des pratiques médicale, les chirurgiens du rachis sont
particulièrement impactés par le rôle de la responsabilité médicale et du risque de faute professionnelle
dans leurs actions et leurs décisions. Notre objectif était d'évaluer les évolutions possibles de la pratique
des neurochirurgiens privés fortement exposés à ce risque judiciaire et de détecter les altérations de leur
plaisir à exercer de leur profession. Nous présentons la première enquête française sur la perception par
des praticiens de la judiciarisation chirurgicale et de ses conséquences sur leur pratique.

Page 4 of 19
Journal Pre-proof
Méthodes
Une enquête en ligne a été soumise aux 121 membres de la Société Française des Neurochirurgiens
Libéraux (SFNCL), qui représentent 29,1% du nombre total de chirurgiens du rachis en France et
réalisent 36,0% de l'activité nationale totale des chirurgies rachidiennes. La loi française (Loi de 2002,
commission conciliation indemnisation) a un impact important sur les chirurgiens privés exposés en cas
de litige.
Résultats
Au total, 78 réponses ont été obtenues (taux de réponse de 64,5 %) : 89,7 % des répondants ont décrit
une dégradation de la relation médecin-patient liée à la judiciarisation et 60,2 % ont déjà refusé de
pratiquer des interventions à risque. La crainte d'une procédure judiciaire a ajouté une pression négative
pendant les interventions chez 55,1 % des répondants et 37,2 % d'entre eux ont déjà envisagé de cesser
leur pratique en raison de ce contexte accru de litige.
Conclusion
L'impact croissant des procédures de plainte incite les praticiens à modifier leur pratique et leurs
perceptions. La relation médecin-patient en est modifiée, des pressions négatives sont exercées sur les
médecins et, sur le plan défensif, certains neurochirurgiens peuvent refuser des patients et des
interventions à risque élevé. Cette situation provoque un désenchantement professionnel et peut
finalement s'avérer désavantageuse tant pour les médecins que pour les patients.