Acute Aortic Disease.. - Index of

SECTION V: LITIGATION IN AORTIC ANEURYSM DISEASE
18
Legal Considerations in Acute
Aortic Diseases †
John A. Elefteriades
Section of Cardiothoracic Surgery, Yale University,
New Haven, Connecticut, U.S.A.
INTRODUCTION
Most of this book concentrates on pathogenesis, imaging, diagnosis, and treatment
of acute aortic diseases. There is, however, another major dimension to the
care of patients with acute aortic diseases that it behooves us not to ignore—
the medical-legal dimension.
As is well known, we in the United States find ourselves in the midst of a
worsening crisis of medical malpractice litigation. This crisis is said to contribute
to cost of healthcare through increased liability insurance expenses and through
excess “defensive” patient testing (1,2). This crisis is said to be driving physicians
out of high-cost states and high-risk specialties (3). Malpractice-related
psychological forces are said to cause major emotional stress to physicians,
manifest both at work and at home (1,4–7). Residency training is affected markedly
by medico-legal concerns (4). Liability concerns and related expenses are
thought to be among the major factors affecting choice of specialty for physicians
in training (4,8). This is thought to be a factor in the alarming fall in applicants
for residencies in Cardiothoracic Surgery. Among the six medical disciplines that
face the highest frequencies of litigation and the highest malpractice rates (1,3,8),
four are involved intimately in the assessment and treatment of acute presentation
of aortic diseases: surgical specialties (cardiothoracic), radiology, emergency
medicine, and anesthesiology.
† Adapted from an article in press in the journal Cardiology, with permission.
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