Princess Royal Hospital, UK.
Farrar's Building, Temple, UK.
Ann R Coll Surg Engl. 2021 Sep;103(8):553-560. doi: 10.1308/rcsann.2021.0243.
Our study investigated how the standard of surgical care is assessed within the English and Welsh litigation process. The 'shadowline' represents the dividing line between acceptable and unacceptable standards of care. Our hypothesis was that different assessors risk adopting materially different interpretations regarding the acceptable standard of care. Any variation in the interpretation of where the shadowline falls will create uncertainty and unfairness to surgeons and patients alike.
We summarised the legal literature and suggested the factors affecting the assessment of surgical standards. We illustrated our findings on distribution curves.
There was a risk that the shape of the curve and the location of the shadowline may vary according to the assessor. Importantly, a gap may have developed between the legal and clinical shadowlines in respect of the consenting process.
We suggested how a gap between the surgical and legal shadow lines could be narrowed. Clinical governance, balanced literature and realistic expert assessments were all part of the solution.
我们的研究调查了在英国和威尔士的诉讼程序中，如何评估手术护理的标准。“暗线”代表了可接受和不可接受的护理标准之间的分界线。我们的假设是，不同的评估者可能对可接受的护理标准有截然不同的解释。暗线位置的任何解释上的差异都会给外科医生和患者带来不确定性和不公平。
我们总结了法律文献，并提出了影响手术标准评估的因素。我们通过分布曲线说明了我们的发现。
评估者的不同可能会导致曲线的形状和暗线的位置发生变化。重要的是，在同意过程方面，法律和临床暗线之间可能已经出现了差距。
我们提出了如何缩小手术和法律暗线之间的差距。临床治理、平衡的文献和现实的专家评估都是解决方案的一部分。
