1) The problem of what to call an error and what not. Medicine can be quite complex, and it is easy to initiate something that, with the benefit of retrospection, can be "easily" identified as erroneous. That's also called hindsight knowledge.

2) The other issue is that at least some organizations/insurances do not allow a physician to admit guilt - because by doing so, you signalize that the patient has a case.

And if you are victim disabled by a mistake (be it true negligence or a error in competence, egregious or near unavoidable), you might very well sue your docs, apologizing or not, when you loose your job and the bills pile up on your kitchen table. There is little else you can do.

What is an "error in competence, egregious or near avoidable" as opposed to "true negligence"? For that matter, what is "true negligence," as opposed to other kinds of negligence - 'false negligence'?

Negligence is negligence. 'True' or otherwise. Negligence implies a breach of duty, therefore it is actionable under tort law.

Egregiousness denotes something this is extraordinarily bad. Some states require a health care professional to be grossly negligent before they can be sued. Other than that, I can't imagine what egregiousness would have to do with it. Perhaps, except to pump up sympathy with the jury when they are considering damages.

Competence is "adequacy; possession of required skill, knowledge, qualification, or capicity" {thanks, Dictionary.com] and, so, there cannot be an 'error in competence.'

"Near avoidable" is a completely meaningless statement.

Actually, doc, you can file a lawsuit for any claimed level of negligence. Some states require a physician review to state that the claim is worthy, but the standard is quite low, and you can imagine that very few claims get turned down. It is up to the jury to decide whether there is negligence. And egregious actions may be required in order to collect punitive damages (which are almost always uncollectable in medical malpractice cases).

You hit the nail on the head, entdoc: it is up to the (lay-) jury to decide whether there is negligence or not, with the help of partisan experts.

And the question: "negligence or not" is very often not clear; the world is rarely black and white, but shades of grey.

What I meant by true n. vs pseudonegligence, I thought, was pretty clear: there is sthg known as hindsight bias - that is: one calls a reasonable decision as an erroneous one, in retrospect, with outcome knowledge. This fallacy has been nicely demonstrated in medicine and in other fields.

If you think that every "misdiagnosis" is a breach of duty, I think, doc holiday, you are either living in a world where some physicians are infallible (maybe incl. yourself), or you might be a trial lawyer.

The field of medicine, like every other field, is advancing every time. What is considered standard practice of care a year ago might be considered malpractice today. Even then, there are many other complex issues involved in the provision of care.

What about a patient who, based on your understanding of their financial situation, cannot afford the most appropriate medication, and you are forced, as the caregiver to prescribe a substitute which is less appropriate? What if the patient later sues you, and the case review board claims that your care is substandard?

Documentation would be very important in this instance. You document that you discussed the situation with the patient; you recomment X medication; patient states he can't afford it; you stress that you believe X will work better, but offer Y as the next best alternative; patient agrees to Y, making it the patient's decision. Both doctors and patients have to make choices like this all the time.