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Center addresses Perinatal Medicine and Law for residents.

SAN FRANCISCO -- Ob.gyn. residents learn about some pregnancy complications that are so rare that many will never encounter such cases during their careers. Yet few get trained to handle a problem that three-quarters of obstetricians will face at least once--a lawsuit, Dr. William M. Gilbert said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

"I teach my residents how to deal with amniotic fluid embolism or thrombotic thrombocytopenia purpura," said Dr. Gilbert, professor of ob.gyn. at the University of California, Davis. But until recently there was no mechanism at his institution for familiarizing residents with medical malpractice lawsuits.

That is, until he founded the Center for Perinatal Medicine and Law, which has sponsored several mock trials and mock depositions in grand rounds sessions for students and residents in ob.gyn., pediatrics, anesthesia, and radiology. The center has offered a similar session for physicians practicing in the community.

Using interactive technology, observers acted as the jury in the trials. Discussions afterward explored what happened during the trials, he said.

He and an attorney who helped start the programs were motivated by statistics from a liability survey by the American College of Obstetricians and Gynecologists, which covered the period of 1999-2003. The survey found that 76% of ob.gyn. respondents had been sued at least once during their careers, and 57% had been sued at least twice. Half said they had been involved in a legal claim in the past 4 years.

The mock depositions and trials include real lawyers, doctors, and judges. "When they're deposing me in a case, the residents are listening. You can hear a pin drop in the audience. They've never seen it before and don't understand it," Dr. Gilbert said.

He hopes the sessions will familiarize physicians with the ways attorneys can manipulate expert witnesses. "We want to be able to say, 'We're going to learn your secrets and your games and become better physicians because of that.'"

One mock trial, performed before 41 community physicians, involved a physician whose actions were on the edge of standards of care but not negligent. Physicians in the audience with fewer years in practice were more likely to rule for negligence than were more experienced physicians.

That surprised Dr. Gilbert, who had assumed that physicians would vote alike when given the same information. It shows the need for research on expert witness opinions, which he hopes the center can do.

He also plans to survey directors of ob.gyn. training programs to see what, if any, education in legal processes is available elsewhere.

BY SHERRY BOSCHERT

San Francisco Bureau
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Title Annotation:Obstetrics
Author:Boschert, Sherry
Publication:OB GYN News
Date:Oct 1, 2004
Words:439
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