Evidence-Based Pathology and Tort Law: How Do They Compare?



All physicians, including pathologists, work in an environment where most diagnostic problems can be resolved using the certainty of widely accepted facts, and therefore major diagnostic disagreements are uncommon. However, some degree of uncertainty is inevitable when dealing with complex biological systems, and this uncertainty is one factor leading to disagreements. It has increasingly been accepted that an evidence-based approach to both scientific investigation and medical practice is the best approach to reducing uncertainty. Unfortunately, due to deficiencies in current knowledge, some areas of uncertainty cannot be resolved scientifically, and pathologists must rely on the ad hoc use of factors such as authority, consensus, experience, and best judgment to resolve disagreements.

When the tort system addresses allegations of malpractice, it too deals in medical certainty anduncertainty. Disagreements are both routine and contentious, but in contrast to medical practice, the methodology for resolution is highly structured. This methodology leads the tort system to its own conclusions about what is established medical knowledge, what is an area of legitimate medical uncertainty, and what actions by physicians are “standard of care” in these settings. Because the legal system and medicine employ quite different methodology to evaluate physician’s actions, the tort system’s resolution of cases can differ from scientifically-based medical opinion. It has been suggested that improving the scientific quality of physician expert opinion would improve the scientific quality of the decisions reached by tort system. However, efforts aimed at closing the gap between admissible expert testimony and generally accepted medical opinion are in direct conflict with the right of the opposing sides to present their strongest case. In certain jurisdictions, judges now have the power to exclude “outlier” testimony, and undoubtedly, in some instances this has helped jurors to better understand cases.

Physicians would welcome more effective efforts to improve the scientific validity of decisions rendered in malpractice cases, but currently, reform requires that the legal profession itself comes to a consensus that reform is needed. In the absence of this consensus, making even minor changes in legal procedures is extremely difficult. However, when malpractice cases require pathology expert testimony, pathologists themselves have the power to elevate the tort system’s scientific standards. By agreeing to provide expert opinion, and by committing to providing only testimony that is clear, honest, and credible, pathologists enable tort proceedings to function more scientifically, and at the same time they protect their colleagues from the damaging effects of scientifically shabby opinions..


Evidence-based pathology Tort law in medicine Evidence-based pathology in the legal system Medical malpractice and evidence-based medicine 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PathologyUniversity of Virginia Medical SchoolCharlottesvilleUSA

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