Impact of malpractice liability among spine surgeons: A national survey of French private neurosurgeons.

PURPOSE: In the general context of medical judicialization, spine surgeons are impacted by the part that medical responsibility and the risk of malpractice play in their actions and decisions. Our aim was to evaluate possible shifts in practices among private neurosurgeons who are highly exposed to this judicial risk and detect alterations in their pleasure in exercising their profession. We present the first national survey on French physicians' perception of surgical judicialization and consequences on their practice. METHODS: An online survey was submitted to the 121 members of the French Society of Private Neurosurgery, who represent 29.1% of the total number of spine surgeons and perform 36.0% of the national total spine surgery activity. The French law (no-fault out-of-court scheme) significantly impacts these surgeons in the event of litigation. RESULTS: A total of 78 surveys were completed (64.5% response rate): 89.7% of respondents experienced alteration of doctor-patient relationship related to judicialization and 60.2% had already refused to perform risky surgeries. Fear of being sued added negative pressure during surgery for 55.1% of respondents and 37.2% of them had already considered stopping their practice because of this litigation context. CONCLUSION: The increasing impact of medical liability is prompting practitioners to change their practice and perceptions. The doctor-patient relationship appears to be altered, negative pressure is placed on physicians and defensively, some neurosurgeons may refuse high-risk patients and procedures. This situation causes professional disenchantment and can ultimately prove disadvantageous for both doctors and patients.

[Strategies of interpersonal negotiation in children 18-24 months of age (conflict, avoidance and resolution of the conflict)]. / Les stratégies de négociation interpersonnelle chez l'enfant de 18 a 24 mois (conflits, évitement et résolution des conflits).

This research seeks to determine the social competence of children between 18 and 24 months of age. It took place in two consultation centers (PMI) (50 children of North African origin) and two nurseries (20 native children). Each child is observed in a "natural" setting: in a waiting room and during free activity. The sequences in its behavior allow us to pinpoint the conflicts arising between the child and its peers as to who gets what and how an object is used: it also allows us to analyze the negotiating tactics it brings into play: resolution or avoidance tactics. Three conclusions can be drawn: 1. The ways of negotiating depend on the context; 2. The young child's negotiating shows processes of becoming less self-centered that go from mere anticipation to coordinating viewpoints; 3. Each child shows an interactive style. This research could contribute to creating a preventive policy: the pedagogy of conflict and a program for learning to interrelate socially.