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.