In Reply We appreciate the comments and insight by Schaffer et al into the utility and limitations of the Westlaw database used in our article¹ as well as their further explanation of the National Practitioner Data Bank data included in our Supplement. Regarding the limitations of our analysis, we acknowledged in the Limitations section¹ that the level of detail varied given the intended use of the data and that it was being written not by medical professionals but by jury verdict reporters. In addition, as Schaffer et al noted and as reflected in our article, the cases in the database unfortunately represent a small and nonrepresentative sample of cases and are subject to significant reporting bias. Because of these limitations, our study was meant to be qualitative in nature, as reflected by our descriptive language and lack of statistical analyses.¹ While it may be unclear why this study was pursued considering the above and other limitations of this data source, the Westlaw database provided the ability to perform an in-depth analysis of factors that may be contributing to malpractice cases, which most other databases do not provide. However, we acknowledge that a review of LexisNexis may have further enhanced this investigation. We hope that in response to our work and the insightful suggestions by Schaffer et al that researchers with access to other sources of malpractice claims data will expand on our findings to further elucidate the factors that contribute to malpractice claims.

在答复中，我们感谢Schaffer等人对本文第¹条中使用的Westlaw数据库的实用性和局限性的评论和见解，以及对补充资料中包含的National Practitioner Data Bank数据的进一步说明。关于分析的局限性，我们在局限性部分^1中承认鉴于数据的预期用途，详细程度有所不同，并且不是由医学专业人士而是由陪审团裁决记者撰写的。此外，正如Schaffer等人所指出并在我们的文章中所反映的那样，不幸的是，数据库中的案例仅代表一小例且无代表性的案例，并且存在明显的报告偏差。由于这些局限性，我们的研究本质上是定性的，正如我们的描述性语言和缺乏统计分析所反映的那样。^1个虽然可能不清楚为什么要考虑该数据源的上述和其他局限性来进行这项研究，但Westlaw数据库提供了对可能导致渎职案件的因素进行深入分析的能力，而大多数其他数据库却没有提供。但是，我们承认对LexisNexis的审查可能会进一步加强这项调查。我们希望响应我们的工作和Schaffer等人的有见地的建议，即能够获得其他不良行为主张数据的研究人员，将在我们的发现中得到扩展，以进一步阐明造成不良行为主张的因素。