{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:48:55Z","timestamp":1785890935877,"version":"3.56.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Complications in neurosurgery are virtually inevitable due to the specialty\u2019s high-stakes nature. The emotional impact of these events on neurosurgeons is profound, yet little is known about how surgeons cope across different healthcare and cultural systems. Understanding these coping mechanisms is critical to support well-being and reduce burnout. Hence, the authors aimed to characterize the emotional and behavioral responses of neurosurgeons to complications and to examine differences in coping strategies between practitioners in Europe and the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted an international, cross-sectional survey of practicing neurosurgeons and neurosurgery residents. The survey assessed baseline characteristics, experiences with complications, emotional impact, coping behaviors (adaptive and maladaptive), psychological defense mechanisms, and effects on clinical practice and professional confidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 256 respondents (114 Europe, 142 US) completed the survey. Complications were almost universally experienced. Emotional impact was substantial, with 99% reporting at least minimal immediate distress and 98% having persistent long-term effects. Adaptive coping strategies, such as taking complications as teaching opportunities (81%), discussing with partners (64%) or mentors (52%), and engaging in physical activity (57%), were common, whereas maladaptive behaviors, including sleep disturbances (55%), social withdrawal (33%), and procrastination (29%), were also prevalent. Similarly, mature psychological defenses, including humor (57%), affiliation (54%), altruism (50%), suppression (45%), and sublimation (25%), were frequently used, although negative defenses such as intellectualization (70%), rationalization (41%), and isolation (38%) remained common. Some regional differences were observed. US neurosurgeons were more frequently implicated in litigation and were more likely to utilize faith, mindfulness, and therapy (p &lt; 0.05). They also reported utilizing mature defense mechanisms humor, affiliation, and sublimation more commonly than European counterparts (p &lt; 0.05). European neurosurgeons were more likely to question their clinical abilities and less likely to admit fault to the patient every time (p &lt; 0.05). Complications influenced professional confidence (72%) and caused practice modifications in a substantial share of surgeons both short term (43%) and long term (20%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Complications in neurosurgery are unavoidable and associated with substantial emotional burden. Surgeons use a spectrum of coping behaviors and defense mechanisms, with adaptive strategies and mature defenses supporting resilience and professional growth. The principle of \"forgive and remember\" provides a constructive framework: self-forgiveness facilitates moving forward, while remembering and learning from complications supports professional development and improved patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.5.focus26128","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:18Z","timestamp":1785283278000},"page":"E10","source":"Crossref","is-referenced-by-count":0,"title":["An international perspective on grief in neurosurgery: a survey study on how neurosurgeons deal with complications"],"prefix":"10.3171","volume":"61","author":[{"given":"Victor Gabriel","family":"El-Hajj","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keenan","family":"Piper","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carina","family":"El-Hajj","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid","family":"Magdamo","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Turqui Castillo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Atallah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Reid","family":"Gooch","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavropoula","family":"Tjoumakaris","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Rosenwasser","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Luisa","family":"Gand\u00eda-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor E.","family":"Staartjes","sequence":"additional","affiliation":[{"name":"Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, University Hospital Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Do No Harm: Stories of Life, Death, and Brain Surgery","author":"Marsh H","year":"2015","unstructured":"Marsh H. Do No Harm: Stories of Life, Death, and Brain Surgery. Thomas Dunne Books\/St Martin\u2019s Press;2015."},{"issue":"1","key":"b2","series-title":"JVascSocGBIrel","first-page":"5","article-title":"The prevalence and solutions to burnout amongst surgical trainees","volume":"4","author":"Nasim A","year":"2024","unstructured":"Nasim A, Srinivasmurthy D, Searle H, Yu YY. The prevalence and solutions to burnout amongst surgical trainees. JVascSocGBIrel. 2024;4(1):5\u201317. doi:10.54522\/jvsgbi.2024.150"},{"key":"b3","series-title":"J Surg Res","first-page":"482","article-title":"Prevalence and associated factors of burnout in pediatric general surgery fellows","volume":"301","author":"Ochoa B","year":"2024","unstructured":"Ochoa B, Lai K, Eldredge RS, Velazco CS, Weidler EM, van Leeuwen K. Prevalence and associated factors of burnout in pediatric general surgery fellows. J Surg Res. 2024;301:482\u2013491. doi:10.1016\/j.jss.2024.06.037"},{"issue":"1","key":"b4","series-title":"BMC Surg","first-page":"430","article-title":"Surgeon well-being: a systematic review of stressors, mental health, and resilience","volume":"25","author":"Otukoya EZ","year":"2025","unstructured":"Otukoya EZ, Amiri A, Alimohammadi E. Surgeon well-being: a systematic review of stressors, mental health, and resilience. BMC Surg. 2025;25(1):430. doi:10.1186\/s12893-025-03180-5"},{"key":"b5","series-title":"Patient Educ Couns","first-page":"108142","article-title":"AI-powered mental health communication: examining the effects of affection expectations on health behavioral intentions","volume":"122","author":"Qian X","year":"2024","unstructured":"Qian X, Yuan S. AI-powered mental health communication: examining the effects of affection expectations on health behavioral intentions. Patient Educ Couns. 2024;122:108142. doi:10.1016\/j.pec.2024.108142"},{"issue":"10","key":"b6","series-title":"Urol Oncol","first-page":"296","article-title":"Complications and surgeon health: resources for individuals and institutions","volume":"42","author":"Prakash G","year":"2024","unstructured":"Prakash G, Peters CE, Badalato G, Hampson LA, Raman JD, Bagrodia A. Complications and surgeon health: resources for individuals and institutions. Urol Oncol. 2024;42(10):296\u2013301. doi:10.1016\/j.urolonc.2024.02.002"},{"issue":"01","key":"b7","series-title":"Indian J Neurotrauma","first-page":"093","article-title":"Work\u2013life balance for the modern neurosurgeon: her\/his perspective","volume":"21","author":"Prabhune A","year":"2024","unstructured":"Prabhune A, Deora H, Tripathi M. Work\u2013life balance for the modern neurosurgeon: her\/his perspective. Indian J Neurotrauma. 2024;21(01):093\u2013096. doi:10.1055\/s-0043-57250"},{"key":"b8","series-title":"Front Public Health","first-page":"1379280","article-title":"\"I don\u2019t know if I can keep doing this\": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement","volume":"12","author":"McNeill K","year":"2024","unstructured":"McNeill K, Vaillancourt S, Choe S, Yang I, Sonnadara R. \"I don\u2019t know if I can keep doing this\": a qualitative investigation of surgeon burnout and opportunities for organization-level improvement. Front Public Health. 2024;12:1379280. doi:10.3389\/fpubh.2024.1379280"},{"issue":"1","key":"b9","series-title":"BMC Health Serv Res","first-page":"369","article-title":"Effect of burnout among physicians on observed adverse patient outcomes: a literature review","volume":"21","author":"Mangory KY","year":"2021","unstructured":"Mangory KY, Ali LY, R\u00f8 KI, Tyssen R. Effect of burnout among physicians on observed adverse patient outcomes: a literature review. BMC Health Serv Res. 2021;21(1):369. doi:10.1186\/s12913-021-06371-x"},{"issue":"4","key":"b10","series-title":"Psychodyn Psychiatry","first-page":"523","article-title":"Understanding defense mechanisms","volume":"43","author":"Cramer P","year":"2015","unstructured":"Cramer P. Understanding defense mechanisms. Psychodyn Psychiatry. 2015;43(4):523\u2013552. doi:10.1521\/pdps.2015.43.4.523"},{"issue":"2","key":"b11","series-title":"Neurosurg Clin N Am","first-page":"149","article-title":"Errors in neurosurgery","volume":"26","author":"Rolston JD","year":"2015","unstructured":"Rolston JD, Bernstein M. Errors in neurosurgery. Neurosurg Clin N Am. 2015;26(2):149\u2013155,vii. doi:10.1016\/j.nec.2014.11.011"},{"issue":"6","key":"b12","series-title":"Neurosurgery","first-page":"1075","article-title":"Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases","volume":"60","author":"Stone S","year":"2007","unstructured":"Stone S, Bernstein M. Prospective error recording in surgery: an analysis of 1108 elective neurosurgical cases. Neurosurgery. 2007;60(6):1075\u20131080. doi:10.1227\/01.NEU.0000255466.22387.15"},{"key":"b13","series-title":"Surg Neurol Int","first-page":"97","article-title":"Let\u2019s talk about complications","volume":"16","author":"Reuter G","year":"2025","unstructured":"Reuter G, Bruneau M, Molina ES. Let\u2019s talk about complications. Surg Neurol Int. 2025;16:97. doi:10.25259\/SNI_1075_2024"},{"issue":"4","key":"b14","series-title":"Neurosurgery","first-page":"752","article-title":"How do neurosurgeons cope with complications? Results of a nationwide survey","volume":"98","author":"Piper K","year":"2026","unstructured":"Piper K, Magdamo B, Momin A,  How do neurosurgeons cope with complications? Results of a nationwide survey. Neurosurgery. 2026;98(4):752\u2013764. doi:10.1227\/neu.0000000000003671"},{"issue":"2","key":"b15","series-title":"J Patient Saf","first-page":"93","article-title":"The Second Victim Experience and Support Tool: validation of an organizational resource for assessing second victim effects and the quality of support resources","volume":"13","author":"Burlison JD","year":"2017","unstructured":"Burlison JD, Scott SD, Browne EK, Thompson SG, Hoffman JM. The Second Victim Experience and Support Tool: validation of an organizational resource for assessing second victim effects and the quality of support resources. J Patient Saf. 2017;13(2):93\u2013102. doi:10.1097\/PTS.0000000000000129"},{"issue":"7237","key":"b16","series-title":"BMJ","first-page":"726","article-title":"Medical error: the second victim. The doctor who makes the mistake needs help too","volume":"320","author":"Wu AW","year":"2000","unstructured":"Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000;320(7237):726\u2013727. doi:10.1136\/bmj.320.7237.726"},{"key":"b17","series-title":"Proc (Bayl Univ Med Cent)","first-page":"98","article-title":"Managing medical and surgical error: an emotional survival guide","volume":"38","author":"Cox T","year":"2025","unstructured":"Cox T, Columbus C, Eidt JF, Orticio CD, Reynolds E. Managing medical and surgical error: an emotional survival guide. Proc (Bayl Univ Med Cent). 2025;38(1):98-105. doi:10.1080\/08998280.2024.2398314"},{"issue":"4","key":"b18","series-title":"Anesthesiol Clin","first-page":"801","article-title":"Real-time debriefing after critical events: exploring the gap between principle and reality","volume":"38","author":"Arriaga AF","year":"2020","unstructured":"Arriaga AF, Szyld D, Pian-Smith MCM. Real-time debriefing after critical events: exploring the gap between principle and reality. Anesthesiol Clin. 2020;38(4):801\u2013820. doi:10.1016\/j.anclin.2020.08.003"},{"key":"b19","series-title":"Healing the Wounds, A Physician Looks at His Work","author":"Hilfiker D","year":"2013","unstructured":"Hilfiker D. Healing the Wounds, A Physician Looks at His Work. Pantheon Books;2013."},{"issue":"12","key":"b20","series-title":"Mayo Clin Proc","first-page":"1435","article-title":"Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program","volume":"88","author":"Weight CJ","year":"2013","unstructured":"Weight CJ, Sellon JL, Lessard-Anderson CR, Shanafelt TD, Olsen KD, Laskowski ER. Physical activity, quality of life, and burnout among physician trainees: the effect of a team-based, incentivized exercise program. Mayo Clin Proc. 2013;88(12):1435\u20131442. doi:10.1016\/j.mayocp.2013.09.010"},{"issue":"10","key":"b21","series-title":"J Occup Environ Med","first-page":"e487","article-title":"Impact of a participatory wellness continuing medical education program on physician burnout and well-being","volume":"66","author":"Hensrud DD","year":"2024","unstructured":"Hensrud DD, Thompson WG, Rieck TM,  Impact of a participatory wellness continuing medical education program on physician burnout and well-being. J Occup Environ Med. 2024;66(10):e487\u2013e492. doi:10.1097\/JOM.0000000000003190"},{"key":"b22","series-title":"Open Med (Wars)","first-page":"253","article-title":"Intervention for physician burnout: a systematic review","volume":"13","author":"Wiederhold BK","year":"2018","unstructured":"Wiederhold BK, Cipresso P, Pizzioli D, Wiederhold M, Riva G. Intervention for physician burnout: a systematic review. Open Med (Wars). 2018;13:253\u2013263. doi:10.1515\/med-2018-0039"},{"issue":"5","key":"b23","series-title":"BMJ Open","first-page":"e027362","article-title":"Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study","volume":"9","author":"Medisauskaite A","year":"2019","unstructured":"Medisauskaite A, Kamau C. Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study. BMJ Open. 2019;9(5):e027362. doi:10.1136\/bmjopen-2018-027362"},{"issue":"1","key":"b24","series-title":"BMC Public Health","first-page":"1464","article-title":"Adaptive versus maladaptive coping strategies: insight from Lebanese young adults navigating multiple crises","volume":"25","author":"Chaaya R","year":"2025","unstructured":"Chaaya R, Sfeir M, Khoury SE, Malhab SB, Khoury-Malhame ME. Adaptive versus maladaptive coping strategies: insight from Lebanese young adults navigating multiple crises. BMC Public Health. 2025;25(1):1464. doi:10.1186\/s12889-025-22608-4"},{"issue":"1","key":"b25","series-title":"Discov Ment Health","first-page":"114","article-title":"Coping behaviors and mental health during the COVID-19 pandemic: situational and habitual effects on mental distress with hybrid model analysis","volume":"5","author":"Kwon S","year":"2025","unstructured":"Kwon S. Coping behaviors and mental health during the COVID-19 pandemic: situational and habitual effects on mental distress with hybrid model analysis. Discov Ment Health. 2025;5(1):114. doi:10.1007\/s44192-025-00263-w"},{"key":"b26","series-title":"J Prof Nurs","first-page":"156","article-title":"Maladaptive coping behaviors in pre-licensure nursing students: an integrative review","volume":"39","author":"Charlton AC","year":"2022","unstructured":"Charlton AC, Wofford LG. Maladaptive coping behaviors in pre-licensure nursing students: an integrative review. J Prof Nurs. 2022;39:156\u2013164. doi:10.1016\/j.profnurs.2022.01.011"},{"key":"b27","series-title":"Behav Res Ther","first-page":"104288","article-title":"Less is more: decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping","volume":"163","author":"Southward MW","year":"2023","unstructured":"Southward MW, Howard KP, Cheavens JS. Less is more: decreasing the frequency of maladaptive coping predicts improvements in DBT more consistently than increasing the frequency of adaptive coping. Behav Res Ther. 2023;163:104288. doi:10.1016\/j.brat.2023.104288"},{"issue":"5","key":"b28","series-title":"Int J Soc Psychiatry","first-page":"540","article-title":"Coping styles and mental health in response to societal changes during the COVID-19 pandemic","volume":"67","author":"Gurvich C","year":"2021","unstructured":"Gurvich C, Thomas N, Thomas EH,  Coping styles and mental health in response to societal changes during the COVID-19 pandemic. Int J Soc Psychiatry. 2021;67(5):540\u2013549. doi:10.1177\/0020764020961790"},{"issue":"1","key":"b29","series-title":"J Anesth Analg Crit Care","first-page":"36","article-title":"Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study","volume":"4","author":"Vittori A","year":"2024","unstructured":"Vittori A, Petrucci E, Cascella M,  Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study. J Anesth Analg Crit Care. 2024;4(1):36. doi:10.1186\/s44158-024-00171-5"},{"issue":"10","key":"b30","series-title":"JAMA Netw Open","first-page":"e2023256","article-title":"Association of sleep disorders with physician burnout","volume":"3","author":"Weaver MD","year":"2020","unstructured":"Weaver MD, Robbins R, Quan SF,  Association of sleep disorders with physician burnout. JAMA Netw Open. 2020;3(10):e2023256. doi:10.1001\/jamanetworkopen.2020.23256"},{"key":"b31","series-title":"Behav Brain Sci","first-page":"e31","article-title":"Rationalization is a suboptimal defense mechanism associated with clinical and forensic problems","volume":"43","author":"Brody S","year":"2020","unstructured":"Brody S, Costa RM. Rationalization is a suboptimal defense mechanism associated with clinical and forensic problems. Behav Brain Sci. 2020;43:e31. doi:10.1017\/S0140525X19002073"},{"issue":"3","key":"b32","series-title":"Am J Psychiatry","first-page":"356","article-title":"Empirical test of Vaillant\u2019s hierarchy of ego functions","volume":"139","author":"Battista JR","year":"1982","unstructured":"Battista JR. Empirical test of Vaillant\u2019s hierarchy of ego functions. Am J Psychiatry. 1982;139(3):356\u2013357. doi:10.1176\/ajp.139.3.356"},{"issue":"4","key":"b33","series-title":"Eur J Psychiat","first-page":"279","article-title":"Stress and ego-defense mechanisms in medical staff at oncology and physical medicine departments","volume":"21","author":"Kocijan Lovko S","year":"2007","unstructured":"Kocijan Lovko S, Gregurek R, Karlovic D. Stress and ego-defense mechanisms in medical staff at oncology and physical medicine departments. Eur J Psychiat. 2007;21(4):279\u2013286. doi:10.4321\/S0213-61632007000400005"},{"key":"b34","series-title":"BMJ","first-page":"l871","article-title":"Clare Gerada: Doctors and their defences","volume":"364","author":"Gerada C","year":"2019","unstructured":"Gerada C. Clare Gerada: Doctors and their defences. BMJ. 2019;364:l871. doi:10.1136\/bmj.l871"},{"key":"b35","series-title":"World Neurosurg","first-page":"e184","article-title":"Under pressure: emotional reactions to stress of neurosurgeons and neurosurgical trainees","volume":"189","author":"Lin-Siegler X","year":"2024","unstructured":"Lin-Siegler X, Lovett BJ, Wang K,  Under pressure: emotional reactions to stress of neurosurgeons and neurosurgical trainees. World Neurosurg. 2024;189:e184\u2013e190. doi:10.1016\/j.wneu.2024.06.016"},{"issue":"8","key":"b36","series-title":"Intensive Care Med","first-page":"1345","article-title":"Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room","volume":"38","author":"Rohacek M","year":"2012","unstructured":"Rohacek M, Buatsi J, Szucs-Farkas Z,  Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room. Intensive Care Med. 2012;38(8):1345\u20131351. doi:10.1007\/s00134-012-2595-z"},{"issue":"2","key":"b37","series-title":"Health (London)","first-page":"141","article-title":"A colonized general practice? A critical habermasian analysis of how general practitioners experience defensive medicine in their everyday working life","volume":"25","author":"Assing Hvidt E","year":"2021","unstructured":"Assing Hvidt E, Bj\u00f8rnskov Pedersen L, Lykkegaard J, M\u00f8ller Pedersen K, Andersen MK. A colonized general practice? A critical habermasian analysis of how general practitioners experience defensive medicine in their everyday working life. Health (London). 2021;25(2):141\u2013158. doi:10.1177\/1363459319857461"},{"issue":"5","key":"b38","series-title":"J Fam Pract","first-page":"468","article-title":"Defensive testing in Dutch family practice. Is the grass greener on the other side of the ocean?","volume":"44","author":"Van Boven K","year":"1997","unstructured":"Van Boven K, Dijksterhuis P, Lamberts H. Defensive testing in Dutch family practice. Is the grass greener on the other side of the ocean?. J Fam Pract. 1997;44(5):468\u2013472."},{"issue":"2","key":"b39","series-title":"J Eval Clin Pract","first-page":"390","article-title":"Legal concerns trigger prostate-specific antigen testing","volume":"15","author":"Steurer J","year":"2009","unstructured":"Steurer J, Held U, Schmidt M, Gigerenzer G, Tag B, Bachmann LM. Legal concerns trigger prostate-specific antigen testing. J Eval Clin Pract. 2009;15(2):390\u2013392. doi:10.1111\/j.1365-2753.2008.01024.x"},{"issue":"1","key":"b40","series-title":"BMJ Open","first-page":"e057169","article-title":"How defensive medicine is defined in European medical literature: a systematic review","volume":"12","author":"Baungaard N","year":"2022","unstructured":"Baungaard N, Skovvang PL, Assing Hvidt E, Gerbild H, Kirstine Andersen M, Lykkegaard J. How defensive medicine is defined in European medical literature: a systematic review. BMJ Open. 2022;12(1):e057169. doi:10.1136\/bmjopen-2021-057169"},{"issue":"22","key":"b41","series-title":"Arch Intern Med","first-page":"2565","article-title":"How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting","volume":"156","author":"Witman AB","year":"1996","unstructured":"Witman AB, Park DM, Hardin SB. How do patients want physicians to handle mistakes? A survey of internal medicine patients in an academic setting. Arch Intern Med. 1996;156(22):2565\u20132569. doi:10.1001\/archinte.1996.00440210083008"},{"issue":"1","key":"b42","series-title":"Sci Rep","first-page":"15081","article-title":"Religious centrality across 22 countries","volume":"15","author":"Woodberry RD","year":"2025","unstructured":"Woodberry RD, Johnson KA, Case B, Bradshaw M, VanderWeele TJ, Johnson BR. Religious centrality across 22 countries. Sci Rep. 2025;15(1):15081. doi:10.1038\/s41598-025-99183-6"},{"issue":"4","key":"b43","series-title":"Transl Androl Urol","first-page":"773","article-title":"Complications: acknowledging, managing, and coping with human error","volume":"6","author":"Helo S","year":"2017","unstructured":"Helo S, Moulton CAE. Complications: acknowledging, managing, and coping with human error. Transl Androl Urol. 2017;6(4):773\u2013782. doi:10.21037\/tau.2017.06.28"},{"issue":"3","key":"b44","series-title":"Neurosurgery","first-page":"e85","article-title":"Neurosurgical complications: forgive and remember","volume":"91","author":"Morcos JJ","year":"2022","unstructured":"Morcos JJ. Neurosurgical complications: forgive and remember. Neurosurgery. 2022;91(3):e85\u2013e87. doi:10.1227\/neu.0000000000002059"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE10.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE10.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/2\/article-pE10.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:01:20Z","timestamp":1785888080000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/2\/article-pE10.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":44,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2026.5.focus26128","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}