Malpractice Suits Research Articles

Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature.

Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting. A retrospective review of the legal literature was performed by searching 3 primary legal databases between the years 1991 and 2010 for cases involving adults with known or suspected OSA who underwent a surgical procedure associated with an adverse perioperative outcome. OSA had to be directly implicated in the outcome, and surgical mishaps (i.e., uncontrolled bleeding) were excluded. The adverse perioperative outcome had to result in a lawsuit that was then adjudicated in a court of law with a final decision rendered. Data were abstracted from each case regarding patient demographics, type of surgery, type and location of adverse event, associated anesthetic and opioid use, and legal outcome. Twenty-four cases met the inclusion criteria. The majority (83%) occurred in or after 2007. Patients were young (average age, 41.7 years), male (63%), and had a known diagnosis of OSA (96%). Ninety-two percent of cases were elective with 33.3% considered general procedures, 37.5% were ears, nose and throat procedures for the treatment of OSA, and 29.1% were considered miscellaneous interventions. Complications occurred intraoperatively (21%), in the postanesthesia care unit (33%), and on the surgical floors (46%). The most common complications were respiratory arrest in an unmonitored setting and difficulty in airway management. Immediate adverse outcomes included death (45.6%), anoxic brain injury (45.6%), and upper airway complications (8%). Overall, 71% of the patients died, with 6 of the 11 who suffered anoxic brain injury dying at an average of 113 days later. The use of opioids and general anesthetics was believed to play a role in 38% and 58% of cases, respectively. Verdicts favored the plaintiffs in 58% of cases and the defendants in 42%. In cases favoring the plaintiff, the average financial penalty was $2.5 million (±$2.3 million; range, $650,000--$7.7 million). Perioperative complications related to OSA are increasingly being reported as the central contention of malpractice suits. These cases can be associated with severe financial penalties. These data likely underestimate the actual medicolegal burden, given that most such cases are settled out of court and are not accounted for in the legal literature.

Empathy for Patient Centeredness and Patient Empowerment

Empathy involve internal process of experiencing what is perceived from the outside world through our senses leading to imaginations and projections, so that such experience will turn the belief of “I and you” in to “I am you” or at least “I might be you”. According to Hojat, empathy in clinical practice is predominantly a cognitive attribute that involves understanding and communicating this understanding with an intention to help by alleviating pain and suffering. Unlike sympathy, empathy is trainable through experiential learning that involves all 4 domains of learning; cognitive, psychomotor, affective and interpersonal domains. Intellectual understanding of the situations (cognitive),emotional feeling and motivation (affective) results in actions with commitment (psychomotor) leading to the expression of his/her intension to help others (interpersonal). Enhancing empathy is beneficial as a parallel improvement of the professional development and patient outcomes is expected. The relationship between the intensity empathy and its beneficial outcomes has a linear relationship. However the relationship of sympathy and its beneficial outcomes shows an inverted U shape, indicating beneficial effects of enhancing sympathy progress only up to a certain limit and after that it start declining. The affective nature of sympathy leads to spontaneous reactions causing distress and deterioration of the efficacy leading to confusions and vicarious trauma. Therefore sympathetic reactions are not productive for health care professional. Empathy is a trainable attribute that contributes to the efficacy in communication, therapeutic adherence and success of treatment and finally to the satisfaction of patients as well as health care professional. Empathetic doctors are less liable for malpractice suits. Empathy promotes feeling of sameness, parallel position and respect that is conducive for patient centered attitudes. However unlike egocentric sympathy, empathy demonstrates altruism and recognizes “separateness” while retaining the feeling of sameness. The health care provider understands that the healthcare receiver is not he or her but another independent individual. Therefore empathy promotes the view that “one needs to look after themselves”. This perception motivates health care professionals to another commitment, which is to empower their patients through deliberate practices like motivational counseling. Sympathetic health care professional will focus on patient satisfaction while empathetic health care professional will focus on patient empowerment. All the religions promote empathy; understanding, feeling and supporting others to alleviate pain. Perception of separateness while experiencing the suffering of the others that will prevent attachments and vicarious trauma is also probably embedded in all regions. I have quoted explicit in examples from Buddhist philosophy due limited knowledge about teaching in other religions regarding these concepts

How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices. We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits. Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions. Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents. Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.

Electronic Health Record-Related Events in Medical Malpractice Claims.

BackgroundThere is widespread agreement that the full potential of health information technology (health IT) has not yet been realized and of particular concern are the examples of unintended consequences of health IT that detract from the safety of health care or from the use of health IT itself. The goal of this project was to obtain additional information on these health IT–related problems, using a mixed methods (qualitative and quantitative) analysis of electronic health record–related harm in cases submitted to a large database of malpractice suits and claims.MethodsCases submitted to the CRICO claims database and coded during 2012 and 2013 were analyzed. A total of 248 cases (<1%) involving health IT were identified and coded using a proprietary taxonomy that identifies user- and system-related sociotechnical factors. Ambulatory care accounted for most of the cases (146 cases). Cases were most typically filed as a result of an error involving medications (31%), diagnosis (28%), or a complication of treatment (31%). More than 80% of cases involved moderate or severe harm, although lethal cases were less likely in cases from ambulatory settings. Etiologic factors spanned all of the sociotechnical dimensions, and many recurring patterns of error were identified.ConclusionsAdverse events associated with health IT vulnerabilities can cause extensive harm and are encountered across the continuum of health care settings and sociotechnical factors. The recurring patterns provide valuable lessons that both practicing clinicians and health IT developers could use to reduce the risk of harm in the future. The likelihood of harm seems to relate more to a patient's particular situation than to any one class of error.

How a Lumbar Diskectomy Influenced Medical Malpractice and the Landscape of Health Care

Jeff Chandler was one of Hollywood's top leading men in the 1950s and 1960s. In 1961, at the peak of his career, Chandler died of complications following an aortic-iliac injury during a routine lumbar diskectomy. The subsequent public outcry and malpractice suit resulted in an unprecedented settlement award. Chandler's lawsuit marked a pivotal time in the evolution of medical malpractice and monetary awards. Before 1960, malpractice legal claims were rare, with little impact on the practice of medicine. Chandler's award, however, dwarfed the average malpractice verdict for its time and would influence the relationship between medicine and the legal world. This case helped issue a radical increase in total expenditure on medical liability insurance, frequency of successful claims, average numbers of neurosurgical malpractice suits, and financial award sizes. The trend ensuing from this time has continued to the contemporary era. To link Chandler's case to the current malpractice climate, we highlight the relationship of the case with 3 factors comprising the legal argument for the perpetuation of medical malpractice: 1) contingency fees, 2) citizen juries, and 3) the nature of tort law. This case illustrates an inflection point in American medical malpractice expenditure increases beginning in the 1960s to a current estimated $55.6 billion. As we investigate ways to provide value in health care, it is important to consider the historical factors that have influenced the status quo when seeking strategies to reform the malpractice system on both sides of the value equation: quality and cost.

No scalpel vasectomy: 20 year outcomes utilizing combined cautery, clip and facial interposition

Vasectomy failure is common (1-10%) and a major cause of malpractice suits. No-scalpel vasectomy (NSV) is a minimally invasive technique, but failure rates are dependent on occlusion techniques. In this report, a combination of 4 occlusion techniques were employed. Retrospective chart review. All men who underwent NSV by a single surgeon within the past 20 years were included. For NSV the vas was delivered through a single midline puncture hole under local anesthesia, excluding vasal vessels and nerves. The vas was hemi-transected in two places ½-1 cm apart using thermal cautery. Intraluminal cautery was performed on both ends for a distance of 1cm until smoke was observed and the wire tip then rotated for 10 seconds to ensure a 360o burn. A hemoclip was lightly placed on the testicular end to prevent sperm leakage until cautery causes a permanent seal. The abdominal end was completely transected and allowed to retract into the vasal sheath. The sides of the sheath were grasped with a hemostat and sealed over the abdominal end with a hemoclip, accomplishing fascial interposition. The intervening vas segment was excised and the ends were dabbed with Betadine before retraction into the scrotum. The contralateral vas was accessed through the same puncture hole and occluded identically. Post-vasectomy semen analysis (PVSA) is requested after 6 weeks or 15 ejaculations, and a PVSA after the same interval. 646 vasectomies were performed over 20 years. Mean patient age in years was 41.5±5.8 and partner 38.7±3.7. Median # of children was 3. 377/646 men (58%) of men had at least one PVSA performed a median of 55 days after NSV. 177/377 (47%) required a second PVSA, of which 138/177 (78%) complied. No pregnancies were reported. One patient had redo NSV for persistent non-motile sperm on PVSA. One abscess required I&D. Two hematomas (2-3 cm) were managed conservatively. No chronic (>6 months) post-vasectomy pain was reported. Vasectomy failure can be virtually eliminated utilizing a combination of 4 different occlusion techniques: 1) intraluminal cautery for 10 seconds; 2) testicular end clip occlusion; 3) facial interposition; and 4) resection of a ½ - 1 cm segment. This approach can be employed using the no-scalpel technique through a single midline puncture hole. Delivery of vas cleanly from its sheath, excluding vasal vessels and nerves may minimize the incidence of chronic post-vasectomy pain. This belt, suspenders, rope and wire approach to vasal occlusion minimizes failure and complications.

Book Review: “Blink: the power of thinking without thinking”

Book Review: “Blink: the power of thinking without thinking”

Errors and malpractice lawsuits in radiology: what the radiologist needs to know.

All medical specialties dealing with patients include an intrinsic risk in exposing them to issues resulting from human errors. Radiology is not spared from this risk since it includes "decision-making under conditions of uncertainty." In medical imaging, the line between the word "error" and misdiagnosis or discrepancy is very difficult to demarcate, mainly because the diagnostic process is not a binary relation and it is not always possible to establish if a pathological condition is present or not. The error in radiology is strongly related to the diagnostic process; hence, it can be defined as a "diagnostic error" which represents the most common cause of medical malpractice suits against radiologists. In this paper, the authors described the features of errors occurring in radiology, trying to establish their impact and prevalence. Secondly, some data coming from different countries were compared in order to highlight the most frequent causes leading to malpractice lawsuits in radiology and how the phenomenon of malpractice in this field is represented worldwide.

Popularity of internet physician rating sites and their apparent influence on patients' choices of physicians.

BackgroundThere has been a substantial increase in the number of on-line health care grading sites that offer patient feedback on physicians, staff and hospitals. Despite a growing interest among some consumers of medical services, most studies of Internet physician rating sites (IPRS) have restricted their analysis to sampling data from individual sites alone. Our objective was to explore the frequency with which patients visit and leave comments on IPRS, evaluate the nature of comments written and quantify the influence that positive comments, negative comments and physician medical malpractice history might have on patients’ decisions to seek care from a particular physician.MethodsOne-thousand consecutive patients visiting the Pre-Operative Evaluation (POE) Clinic at Mayo Clinic in Rochester Minnesota between June 2013 and October 2013 were surveyed using a written questionnaire.ResultsA total of 854 respondents completed the survey to some degree. A large majority (84 %) stated that they had not previously visited an IPRS. Of those writing comments on an IPRS in the past, just over a third (36 %) provided either unfavorable (9 %) or a combination of favorable and unfavorable (27 %) reviews of physician interactions. Among all respondents, 28.1 % strongly agreed that a positive physician review alone on an IPRS would cause them to seek care from that practitioner. Similarly, 27 % indicated that a negative IPRS review would cause them to choose against seeking care from that physician. Fewer than a third indicated that knowledge of a malpractice suit alone would negatively impact their decision to seek care from a physician. Whether a respondent had visited an IPRS in the past had no impact on the answers provided.ConclusionsFew patients had visited IPRS, with a limited number reporting that information provided on these sites would play a significant role in their decision to seek care from a particular physician.

Malpractice in colorectal surgery: a review of 122 medicolegal cases

BackgroundMedical malpractice has become a rising concern for physicians, affecting the cost and delivery of health care. Colorectal procedures account for 24% of all general surgery cases, a high-risk specialty, with 15% of its physicians facing malpractice suit annually. MethodsThe Westlaw legal database was used to identify colorectal malpractice cases. ResultsIn all, 122 of 230 lawsuits were included in this study. A majority of 65.6% were physician verdicts, 19.7% plaintiff verdicts, and 14.8% reached a settlement. Plaintiff payments were found to be significantly higher than settlement awards. The most common cause of alleged malpractice was failure to recognize a complication in a timely manner (45.1%), followed by damage to surrounding tissues (36.1%). ConclusionsThe most common cause of alleged malpractice was failure to recognize a complication in a timely manner, followed by damage to surrounding tissue. Plaintiff awards were significantly higher than settlement payments. It is important to understand the mechanism of malpractice allegations to better prevent litigation and improve patient care.

“I'm Sorry” as Evidence? Why the Federal Rules of Evidence Should Include a New Specialized Relevance Rule to Protect Physicians

IN March 2013, Marek Lapinski, a healthy twenty-four-year-old software developer and entrepreneur, reported to Temecula, California office of Dr. Steven Paul, an oral surgeon, to have his wisdom teeth extracted. (1) Mr. Lapinski did not survive routine procedure. (2) According to a patient care report, he awoke, coughing, during operation, was sedated with propofol, and stopped breathing. (3) He died three days later at hospital. (4) April Lapinski, patient's mother, said of Dr. Paul, who was present at hospital, [H]e said he was sorry. (5) After an autopsy pointed to an anesthesia overdose as cause of death, (6) Lapinski family filed a medical malpractice suit against Dr. Paul in Los Angeles County on March 19, 2014. (7) A September 2015 trial date has been set. (8) As trial approaches, an interesting question could arise as to legal consequences of Dr. Paul's apology to Mrs. Lapinski. Could it be used as evidence of Dr. Paul's negligence, despite fact that it could just as likely have been nothing more than an expression of empathy intended to comfort grieving family? The use of apologies as evidence of liability is a recurring issue in medical malpractice litigation. The Federal Rules of Evidence currently contain no provision barring physicians' apologies (9) to patients from being admitted as evidence of fault. Whether state law offers any protection varies from jurisdiction to jurisdiction, and even where some degree of protection is offered, whether those protections apply depends on content of apology in question. This article argues that such protection is necessary, and because underlying policy of protecting apologies is consistent with rationales supporting specialized relevance rules that are already included in Federal Rules of Evidence, an additional rule should be added to govern admissibility of physicians' apologies. Because many states' evidence rules are modeled after Federal Rules, such an addition would be a persuasive and effective means of demonstrating federal government's commitment to fostering doctor-patient relationship--and of encouraging states to do same. I. The Federal Rules of Evidence and Specialized Relevance Rules A. The Role of Federal Rules of Evidence The Federal Rules of Evidence, which took effect on June 1, 1975, (10) were product of a thirteen-year process initiated by then-Chief Justice Earl Warren to draft and enact uniform rules of evidence for use by federal courts. (11) Rather than attempting to codify federal statutory and judge-made law of evidence that existed at time, drafters of Rules instead looked for inspiration to states' efforts to codify their own evidentiary rules. (12) With enactment of Federal Rules of Evidence federal government again took lead; by 2003, forty-two states had statutory evidence codes or court rules modeled after Federal Rules. (13) States are not obligated to follow Federal Rules. (14) Rather, they may deviate as much or as little as they see fit. California, for example, uses its own evidence code, which pre-dates Rules. (15) Pennsylvania's Rules of Evidence also deviate in some respects from Federal Rules in pursuit of the guiding principle of preservfing] Pennsylvania law of evidence. (16) Perhaps most noteworthy of these departures is Pennsylvania's rejection of federal Daubert (17) standard for admissibility of expert evidence in favor of pre-Rules Frye (18) general acceptance standard. (19) Still, most recent revision of Pennsylvania rule governing admissibility of expert testimony bears a strong resemblance to language and organizational structure of corresponding Federal Rule. (20) This example illustrates that, while states can and do depart from Federal Rules at times, Federal Rules nonetheless play an influential role in serving as a model for law of evidence in great majority of states, even when those states decline to adopt federal Rules to letter. …

The New Malpractice of Remote Care

The New Malpractice of Remote Care

The malpractice liability of radiology reports: minimizing the risk.

The art and science of interpreting radiologic examinations, an ability that is acquired over years of training, is on display in every radiology report. It is vital that these reports be crafted so as to both reflect the radiologist's expertise and capability and eliminate any factors that might result in unintended harm to the patient. Unfortunately, a deficient report may result in legal action against the radiologist; thus, a thorough understanding of the litigious potential of the language used in radiology reports is crucial. It is important that ambiguous vocabulary, undefined modifiers, double negatives, and generalizations be avoided. Errors in radiology reports may result from inappropriate terminology, transcription mistakes, or deficient or inadequately documented communication. Critical findings that may have an immediate impact on patient management must be promptly communicated to the referring physician and such communication fully documented. A meticulous and well-written report is the best way for radiologists to care for their patients. In addition, a well-worded report can be the deciding factor in a successful defense against a malpractice claim. Understanding the legal implications of radiology reports will enable radiologists to develop strategies for avoiding malpractice suits.

Malpractice 101: Strategies for Defending Your Practice

If you work in the medical field, you probably fear that someday you may be sued. Lawsuits are scary, and the process is intimidating. Lawsuits can take years to resolve. You may spend a significant amount of time reviewing records and imaging studies, meeting with insurance claims investigators, risk managers, and your own lawyer. As the lawsuit progresses, you may have to give a deposition under oath. If there is no resolution of the matter, it will proceed to trial. The trial will typically last between 1 and 2 weeks, depending on the complexity of the issues involved. If you are named in the lawsuit, you are expected to attend the trial every day. You will gain a new respect for the jury system and will look at a jury summons in a whole new light. The purpose of this article is to help radiology nurses understand litigation, especially malpractice. Having this information will allow the radiology nurse to examine his or her own practice and assess if one can make small changes to everyday activities to improve the chances of successfully preventing or defending any malpractice suit and, more importantly, to improve patient outcomes. The rules governing litigation vary by jurisdiction. These are some general rules but, of course, your attorney will tell you what you need to know in your area.

Low Rate of Myocardial Infarction After an ED Visit for Chest Pain

Historically, missed myocardial infarction (MI) was a common reason for malpractice suits, and the rate of missed MI was high. More recent data suggest

Insuring That Good Deeds Go Unpunished: Instituting State‐Provided Malpractice Protection for Pro Bono Family Lawyers

In the face of an economic downturn, more litigants are attempting to handle family law actions without representation and the consequences could be disastrous for them. Although some legal aid is available, more pro bono services are needed, and many family lawyers who would otherwise volunteer do not do so because they fear becoming defendants in a legal malpractice suit. Most prospective volunteers do not have the right malpractice insurance and are not covered by current state or federal law. This Note proposes that all states recognize the increasing malpractice exposure risk for family lawyers and incentivize them to volunteer by implementing statewide programs that provide free malpractice insurance for volunteer family lawyers modeled after existing programs in Missouri and Texas. Such programs would recognize that volunteer attorneys are doing a good deed, but also protect every client's right to adequate legal representation, by preserving their right to sue for malpractice. Key Points for the Family Court Community More litigants in family court actions are deciding to represent themselves due to their inability to pay market rates for legal services. Although some legal aid is available, more pro bono services are needed. Many family lawyers do not volunteer due to fear of being sued for malpractice. A state‐implemented malpractice insurance plan for volunteer family lawyers would be a low‐cost program that would minimize attorney fears, create incentives to volunteer, and serve as an effective solution to the increasing rate of self‐represented litigants in family court actions.

Surgical assessment of complications after thyroid gland operations

The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.

Radiology medical malpractice suits in gastrointestinal radiology: prevalence, causes, and outcomes.

The purpose of this study is to determine the prevalence, causes, and outcomes of GI malpractice suits in a survey of 8,401 radiologists. The malpractice histories of 8,401 radiologists from 47 states were evaluated from credentialing data of all radiologists participating in the network of One Call Medical Inc. Thirty-two percent of radiologists were defendants in at least one malpractice suit. Of the 4,073 total claims, 346 (8.49 %) were related to the gastrointestinal system. The most frequent primary allegations were failure to diagnose, 65.9 %, and procedural complications, 17.1 %. The commonest missed diagnoses were malignancy, 31.6 %; pneumoperitoneum, 19.3 %; and appendicitis, 14.5 %. Payment to the plaintiff occurred in 75.8 % of claims pertinent to cancer, 73.2 % for missed pneumoperitoneum, and 62.5 % related to appendicitis. Of cases in which a ruling was made in favor of the plaintiff, median payments for pneumoperitoneum was $215,000, for primary cancer $200,000, and for appendicitis $60,000. Among procedurally related errors resulting in judgment against a defending radiologist, 78.6 % of claims regarding retained foreign body, 75 % of barium enema cases, and 62.5 % of liver biopsy resulted in a payment to the plaintiff. Among all resolved cases, the median award was $30,000 for unrecognized foreign body retention, $100,000 for barium enema complications, and $400,000 for liver biopsy complication. Of all GI malpractice claims, failure to diagnose was the most prevalent. Among them, approximately three fourths of claims related to either the diagnosis of primary cancer or for detection of a pneumoperitoneum.

Second opinion in breast pathology: policy, practice and perception

AimsTo assess the laboratory policies, pathologists’ clinical practice and perceptions about the value of second opinions for breast pathology cases among pathologists practising in the USA.MethodsCross-sectional data were collected from...

Dimensions of quality care affecting career satisfaction of pediatricians.

This study investigated factors impacting career satisfaction among pediatricians. The study used data from the 2008 Health Tracking Physician Survey, conducted by the Center for Studying Health System Change. The 2008 Health Tracking Physician Survey data set consisted of 4720 physicians who were members of the American Medical Association. Among the respondents, 427 identified themselves as pediatricians. Results indicated more than 52% of pediatricians were very satisfied with their careers in medicine. Nearly 35% of pediatricians were older than 48 years. Approximately 48% were male, and 67% were of white race. The average respondent worked 45 hours per week in medically related activities. Regression analysis indicated the following had a significant impact on pediatrician career satisfaction: inadequate time with patients, patient noncompliance, and delayed reports from other physicians and facilities. Number of hours worked per week and worry over potential malpractice suits also had a significant impact on career satisfaction of pediatricians.