Pragmatism and Professionalism

In its nature, surgery is a pragmatic profession. From the initial visit to the dissecting room as a medical student, we realise that reality rarely mirrors the textbook precisely. Dealing with variety and unplanned challenges are key skills for surgical practice, as they are for life in general.

Benedict Rogers, Editor-in-Chief of the Annals of the Royal College of Surgeons of England

Medicolegal action is one such challenge that all surgeons will meet in their careers, a matter of ‘when’ not ‘if’. While we all strive to minimise litigation, the manner in which we react to and deal with medicolegal action is just as important.

As aviation learns from air crash investigations, so should surgery continually learn from errors. The demands of medicolegal action should focus on learning for individuals, organisations and the whole profession. Who has read a medicolegal case report and not wondered ‘there but for the grace of God, go I’? Education of all should be the prime driver and outcome of medicolegal action, rather than blame, retribution or financial reward.

It is to this goal that this edition of Annals contains several medicolegal themed pieces of original research. Furthermore, by way of prologue and to highlight importance, we publish a guest editorial by Daniel Sokol,¹ renowned medical negligence barrister and medical ethicist. I thank him greatly for his contribution and encourage all to read and learn from his words.

As surgeons, we should have insight and understanding that the ideas, concerns and expectations of a claimant, solicitor and clinician will frequently not be aligned, in parallel to that in a patient-doctor consultation. While this should not be surprising - we are trained and work in clinical rather than legal practice - I suspect such objectivity is not easily afforded.

From a personal perspective, my practice continues to evolve in light of gaining knowledge and insight from medicolegal studies and I believe that reducing medicolegal risk concurrently minimises, though not eliminates, clinical risk. Patients, colleagues and society expect the utmost transparency and professionalism.

In a separate matter, it is my duty as Editor-in-Chief to highlight two manuscripts previously published in the Annals of The Royal College of Surgeons of England.^2,3 The Annals production team and I have been made aware that both articles bear close similarities to articles recently published in other peer reviewed journals.^4,5 In accordance with the Committee on Publishing Ethics guidelines,⁶ all relevant authors and editors have been informed.

I understand considerable differences in policy and practice may exist between journals, and after investigation we have only retracted one of the Annals articles.³ With regard to the other article,² we wish to state an expression of concern and invite the reader to draw their own conclusions after reading the article.