Table 1.

Main themes, selected subthemes, and quotations referring to them

Main themes	Subthemes	Selected quotes
Contextualization of the private practice of spinal surgery	Particularity of the private practice	They know that in Hospital they are covered, that the Hospital will take care of it, actually many of them do not even attend expert assessments themselves if they work in the hospital... well yes it’s a Hospital so there’s the medical adviser, the lawyer who represents the Hospital, every so often the practitioner but not always... Surgeon_7
Societal transformation of the doctor-patient relationship	Health as a right: the demand for results	Whatever specialists or legal experts or angelic people might say, we are slipping away from an obligation of means to an obligation of result. Surgeon_1
Judicialization of spinal surgery	Surgical view of the motivations behind complaints	I’ve seen it when it comes to expert reviews, there are lots of cases that are not justified, yeah, it really is nonsense. Surgeon_11
	The meta-responsible	It’s hard when you go to an expert review because you know that you are going to be judged, that you are going to be judged not impartially but aggressively by most of the people who are there, because there’s someone with the status of victim and then there’s you, the surgeon, a priori considered guilty Surgeon_10
Coping strategies	Strengthen consultation information and trackability	It does not necessarily benefit the patient, but the surgeon will be protected on file, you see, they’ll have ticked that box. That represents an important change in practices, that is to say, we are not doing it for the patient but rather in order to protect ourselves. Surgeon_1
	Transfer the patient to the public hospital	Whenever there are patients who I consider to be too risky to treat privately because I would be too exposed to liability, then indeed, I prefer to refer them to the university hospital. Surgeon_9
Professional disenchantment	Disenchantment	Again, it does affect me. I’ll tell you this now actually, I was thinking about it on the way home earlier- For me, it’s one of the things, you know, well now I’m approaching retirement age, I can tell you I’ll hang in there for one, two, five more years... but if anything were to make me quit earlier it would be that. It’s unbearable. You reach a point where it becomes... well, you try to do your job well, you work hard, but you get knocked back sometimes like everyone else and you are systematically being blamed... I reckon that at the moment, at my age, that’s the part of the job that bears down on me the most. Surgeon_5
	New horizons	In other countries, surgeons are working in great conditions: they work much less because their fees are much higher and fuck, they are chilled, they are relaxed! Surgeon_11

A larger selection of quotes is available in Appendix as Electronic Supplementary Material