Reading the record: what medicolegal review teaches surgical leaders

Medicolegal expert witness work is often understood in procedural terms: reviewing records, assessing standard of care, considering causation, preparing reports and, at times, giving testimony. For clinicians, however, this work can also become an unexpected form of leadership education. It offers a distinctive view of adverse outcomes, documentation, uncertainty, accountability and the records that remain after care has been delivered.Drawing on 5 years of medicolegal review in plastic surgery and related areas of complex surgical care, this article reflects on what expert witness work has taught me about surgical leadership. Retrospective review is powerful, but vulnerable to hindsight bias. Clinical records may preserve decision-making, escalation and communication, but may also fail to capture fatigue, ambiguity, urgency and system constraints. Poor outcomes are not always evidence of poor care, and imperfect documentation does not necessarily mean that care was poor.Medicolegal review reinforces the importance of documenting reasoning, building just cultures, supporting clinicians after adverse outcomes, listening carefully to patients and families and examining systems as well as individuals. It reminds surgical leaders that accountability and compassion are not opposites. The fairest assessments of care are independent, evidence-informed, humane and attentive to the realities of clinical practice.