In recent years the United States has undergone what some have termed a malpractice “crisis”. It has affected Canada and other parts of the world to a lesser extent and has been the subject of much debate. Throughout history the idea of what constitutes negligent surgical care and its consequences has not been an immutable concept but rather has fluctuated between seemingly polar extremes.
In ancient Mesopotamia, the Hammurabi code describes bountiful rewards for successful surgery contrasted with mutilation or death for failed attempts. In ancient Egypt we see the extremes of strict dogma, where acceptable practice was laid out by ancient priestly documents and those who strayed from their precise format could be met with deportation or beheading, a practice that discouraged developing treatment for those with a poor chance of survival. In stark contrast to these cultures the physician/surgeons of ancient Greece had almost complete impunity. After the monastic orders in Europe were banned from surgical practice in 1130 the uneducated barber surgeons dominated the field. The minority of educated surgeons pointed out many examples of negligence and improper care by this group. Capital punishment and mutilation of negligent surgeons became common once again in the crusader states, as public humiliation was added to the punishment. During the renaissance in Italy, the actions of a regulatory council levied stiff fines for surgeons who infringed on the practice of physicians while seemingly paying very little attention to examples of gross negligence and patient abuse. Finally in the modern era, surgery developed much more effective treatments for many conditions. Paradoxically as soon as a technique became better for a condition, accusations of negligence for treatment of that condition became common.
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