The Pathologist in Tortland

Abstract

In this issue of the Journal , Allen et al1 present the results of a study that asked pathologist volunteers to evaluate a series of pathology malpractice cases (so-called med-mal cases). Based on their evaluation, the volunteers answered two very different questions about each case. First, the pathologists rated the defendant’s care on a scale extending from “correct” to “not correct.” Next, they predicted whether the jury found for or against the pathologist. There was a high level of disagreement among the pathologists themselves and between the pathologists and the juries. These disagreements led the authors to their major conclusion that there is a “clear need for additional education” of pathologists about various aspects of the legal system. In this editorial, I discuss some of the issues raised by Allen et al.1 Sometimes I disagree with their point of view, but the reader should understand that most of the interesting topics in law are, and will remain, subject to various equally valid interpretations. Although determining whether we provided the patient with the standard of care is theoretically central to the legal evaluation of our diagnoses, this phrase is virtually never encountered in medical practice. Surgeons do not send out tissue for a “standard of care frozen section.” We do know that pathologists have a near obsession with the difference between the “right” and “wrong” answer, and we have our own methods to distinguish between the two. However, when we conclude that a diagnosis is wrong, it is an error—not below the standard of care. It might be tempting to dismiss this as nothing more than different terminology used by different professions to describe the same thing. However, despite some similarities, physicians who have had any contact with the legal system recognize that meeting or not meeting a standard …