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Comment and Controversy

2 views of episiotomy highlight legal risk

November 2005 · Vol. 17, No. 11

I was not surprised to see, in Dr. James Greenberg’s commentary in Examining the Evidence (August), the following question: Is routine episiotomy justified? Nor was I surprised by the answer: No.

However, I was surprised to discover, in the Medical Verdicts column in the same issue, a case summary under the headline, “Should episiotomy have been performed?” This case resulted in a jury award of $526,745 for failure to perform routine episiotomy.

The contrasting views highlight the difficulty of practicing good obstetrics without risking legal action. Is it any wonder that most OBs in my area practice defensive medicine, not good medicine?

Howard Nathanson
Bellmore, NY

Dr. Greenberg responds:

It should come as no surprise to any practicing physician that evidence-based medicine and litigation-based evidence are often dissimilar. However, few malpractice cases are won by the plaintiff without “expert” testimony supporting their arguments. Thus, Dr. Nathan’s astute observation should remind us that, before we lay all the blame for the malpractice crisis on the lawyers and legal system, we should remember that, without ObGyns eager to ignore the scientific evidence for financial gain, there would be no contradictory experts.

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