When the surgeon becomes the defendant
As surgeons, we spend much of our careers learning how to deal with complications. We analyse them, we discuss them at morbidity and mortality meetings, we explain them to patients and families, and we try to learn from them.
Litigation is different.
I have experienced the litigation process myself and, I can say that its impact is difficult to appreciate until you have been through it.
Surgery is intensely personal. We make decisions, we accept responsibility and, we quite literally, put our hands on our patients. When something goes wrong, most surgeons will already have replayed the events repeatedly in their own minds long before a solicitor's letter arrives.
Litigation adds another layer.
Suddenly, decisions made in a complex clinical environment are deconstructed months or sometimes years later. Every word in the notes is examined. Decisions which may have been perfectly understandable in the real time can look very different when viewed retrospectively and in isolation.
For me, one of the hardest aspects is the uncertainty. These processes can continue for a very long time; sometime years. Normal clinical life carries on: operating lists, clinics, emergencies, meetings and family life. However, somewhere in the background sits an unresolved allegation about your professional practice.
I, like all of us, can not leave that at work. It follows me around, it disrupts my concentration and sometimes disrupts my sleep.
It can also affect my confidence. You find yourself questioning decisions that previously would have felt straightforward. Should I operate? Should I investigate further? Have I documented enough? Am I taking too much risk?
That response is not unusual. Research examining doctors involved in malpractice claims describes significant psychological distress and associations with burnout, anxiety and changes in clinical practice. Surgeons appear particularly vulnerable. Some doctors become more defensive; others avoid higher-risk procedures or patients altogether.
That should concern all of us.
We absolutely need accountability when care falls below the standard expected. Patients who have been harmed deserve openness, explanation and, where appropriate, redress. But accountability and compassion are not mutually exclusive.
The surgeon involved may also be struggling.
Perhaps we need to become better at asking a very simple question when a colleague becomes involved in a complaint, investigation or claim: 'How are you doing?'
Not as part of the investigation. Not as a governance exercise. Just colleague to colleague.
On 1st October 2026, Gary Spence, our Medicolegal Lead will be hosting a hybrid webinar entitled Litigation and Regulatory Update for Surgeons.
Understanding the legal and regulatory landscape is important. But alongside understanding the process, we should also acknowledge the very human impact that being part of that process can have.
Because behind every claim there may be a patient whose life has been profoundly affected.
And there is also a surgeon quietly carrying it home.
Mr Ravi Vohra
ASGBI Honorary Secretary
