Medicine and the Courtroom

A unique program training new physicians about liability

Sophia is a 38-year-old married, nonsmoking female establishing with a new PCP. Her medical intake form reports a history of chest pain with a negative cardiac workup, thyroid cancer and subsequent hypothyroidism, hyperlipidemia, menorrhagia, GERD, and an esophageal stricture. Her family history is significant for cardiac  disease, HTN, and hyperlipidemia, and she has a surgical history of laparoscopy for an ovarian cyst. She presents with a list of current complaints, none of them urgent, such as sinus problems, headaches, cold intolerance, and she is most troubled by a facial rash.

This is one of several true cases that are posed to residents during Physicians Insurance’s Medicine and the Courtroom—a new, interactive program that brings together attending physicians and their residents, claims experts, and defense attorneys to explore how and why patient care sometimes goes from the exam room to the courtroom.

Using a physician moderator and facilitator, the two-hour program reviews the medicine of the case. Participants learn that Sophia’s life-threatening condition will not be diagnosed for nearly two years, despite care by numerous additional providers —all of whom might have made a positive difference in her outcome.

What happened to Sophia? What might have prevented her poor prognosis and the resulting lawsuit? She saw seven providers in two years. Who might have caught this? What would “medicine in a perfect world” look like in this case? What was the claim? Was there anything unique about how the claim transpired?

Residents wrestle with not just the medicine (the standard of care), but also with patient responsibility and how the system supported or inadvertently hindered patient safety. This type of case-based learning is critical in a medical student’s education career. In fact, according to a recent Health Affairs article, the average physician will spend nearly 11 percent of his or her 40-year medical career with an open, unresolved malpractice claim.*

When new physicians are on-boarded at a clinic, systems may or may not be in place to teach them about liability. Early-to-practice physicians don’t know what the process will demand of them, what the outcome will be, and how it will affect their career. They don’t know if they’ll be able to defend their case or whether it will settle, which prompts mandatory reporting. Larger clinics may have more formal processes for educating their newer staff, but not necessarily. And smaller clinics, those with fewer than 20 physicians, are likely to have little formal training around legal concerns.

Medicine and the Courtroom provides an early introduction to liability, trials, case law, common misperceptions, and the role of the physician during the claim process.

*Seth Seabury, Amitabh Chandra, DariusLakdawalla, and Anupam Jena, “On Average, Physicians Spend Nearly 11 Percent of Their 40-Year Careers with an Open, Unresolved Malpractice Claim,” Health Affairs 32 (2013): 111-119.

For more information about the Medicine and the Courtroom program taking place in Spokane on May 22, contact Physicians Insurance at: (800) 962-1399 or e-mail