Am I the only OB on here?

I *absolutely* believe my colleagues and I practice in a climate of fear. Liz, I'd love to believe that all medmal lawyers are like the one you mentioned, but I know it's not the case. 

I think there are several issues:

(1) bad outcomes are sometimes conflated with physician errors. I personally know an OB who was sued for "emotional distress" because a patient with a positive HIV screen and an indeterminate blot was referred to infectious disease but ended up being HIV negative. 

(2) there is a strange conundrum regarding assumption of risk and informed consent and refusal. I know an obgyn who was approached by a patient who wanted a trial of labor after c section and couldn't find a practice that offered it. She was well versed in the risks and benefits and could articulate the possible complications. She met all ACOG recommendations and went into labor and had a significant uterine rupture that resulted in a c-hyst. She then sued the OB saying that she didn't really understand what she was asking him to offer. And, yes, the judgment was returned in her favor, despite her acknowledgement that she knew uterine rupture could occur. 
This is why a lot of OBs won't do term breech vaginal deliveries. Even if a patient makes an informed decision for a vaginal breech delivery, we worry about the outcome. 

(3) juries are NOT juries of our peers. The nuances of care are often "lost" in trying to discuss good/bad outcomes. (Leading to...)

(4) cases are often decided on "emotion" over evidence. Every study there is on continuous EFM shows that it increases your c section rate and doesn't improve the ability to prevent cp/hie. So, you can have a reassuring intermittent tracing, and if the baby has bad Apgars or cord gasses, the jury wants to know why the baby wasn't being monitored the whole time. It *seems* like continuous EFM should be better, but the evidence shows it's not. (Interesting too that here it's the opposite of vag breech deliveries)

(5) the current system rewards those who file suits, even when unfounded, because hospitals/individuals will settle them rather than assume the costs of litigating them. 

Elizabeth 
(Who hates defensive medicine)

Elizabeth Boggs MD

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