I really think there needs to be some tort reform in this country.
While I've never had a malpractice suit brought against me, several of my colleagues have been sued, and it's a really unpleasant process. Furthermore, every single one of the lawsuits were unjustified. I say this based on the fact that the suits were eventually dropped without any sort of trial or anything like that.
What appears to happen is that when a patient files a lawsuit, every single doctor who has ever said hello to the patient in the hallway or breathed their general air is named in the suit. Then eventually, they drop some of the physicians from the suit who are clearly not involved and didn't do anything wrong. Dropping the innocent physicians from the suit can take years, believe it or not. And during this time, the physician has to live with a lawsuit over their head, and every time they file any of the paperwork for license renewal or privileges at the hospital, they have to provide all the paperwork about the lawsuit.
Another physician was telling me about a lawsuit that was brought against him when the malpractice law was about to change, so the firm quickly filed every suit that they had pending, just to see if any might stick. Again, this was eventually dropped, but it took years.
Being the subject of a lawsuit definitely affects how you practice medicine. It makes you extremely cautious and probably spend way too much ordering extra tests to double cover your ass. Even if you know you didn't do anything wrong, because you really never know until it gets to court.
I'm not a lawyer or in that business so I'm not sure how to change things, but something is definitely wrong with the way it is right now.
The threat of lawsuits affect how we all practice (probably more so how we *document*); I hate it but I don't know how to fix it. I got nuthin'.
ReplyDeleteIt doesn't help that American culture has adopted a pervasive (not limited to medicine) attitude that someone must pay when even a minor mistake is made. In the past, apologies might have sufficed, while now folks expect to be compensated for even small errors or episodes of imperfect service (e.g., at a restaurant). We expect perfect service from anyone we pay and it seems we exercise much less goodwill now than we did 20 years ago.
ReplyDeleteSensational lawyers' ads on TV don't help -- they often offer to sue for known side effects of medications and procedures. There is no 100% safe medication, procedure, or course of action or inaction in medicine. Every possible path carries potential risks and benefits. We aim to maximize the benefits, but there is no infallible algorithm to ensure benefit is maximized. And sometimes there is no option that would result in a good outcome.
The other issue is that our grief systems get overwhelmed when bad things happen to people we love and we may think irrationally. It is easier for many to ascribe fault to an external source than to accept that sometimes bad, unexpected things happen to good people. That's one reason I knew I could not be a pediatrician -- would not want to be held responsible for bad outcomes that were not truly my fault simply because a parent's unimaginable grief trumped good reason.
Looking at numbers for defensive medicine, there's no difference between states where it is easier vs. more difficult to file a malpractice suit. Defensive medicine as a behavior bears little relationship to the risk of being sued. Something else is driving the behavior.
ReplyDeleteAs for why most suits are dropped: money. Most malpractice attorneys work on a contingency basis and won't take small cases (<$25K), so they're dropped, regardless of merit.
That is why I advise people to file complaints with the state medical board. Much more satisfying, and disciplinary actions are public record in most states. Most people don't want money. They want the physician to listen and never harm another patient.
State medical boards are a joke. I can give you links to it and a story you wouldn't believe from Virginia. You are correct on the last line to a point. There are some who do want money to be paid back for what they wasted. I've seen that - as in copays, etc. Most want answers and how things will change, included in that. The problem is that you can't law/jury a doctors' attitude and you definitely won't see that out of administration. They're bigger problems than the doctors.
DeleteI know there are studies that "show" that risk of malpractice does not change medical spending, but I know it changes how physicians practice because I have seen physicians who have been sued change the way they practice. It seems like a natural response. I'm not sure why the studies don't reflect that though.
Delete^ w/ regard to Anonymous above. Yes there is not a correlation between how much defensive medicine is practices in good tort reform states vs bad, but I would say that even in a good state like Texas there is still a good chance you will get sued. The insurance company will have to pay less, but you will still have to put up with all the crap
ReplyDeletePart of the problem has to do with the systems of medicine. Admin doesn't want to pay people or fix systems. Doctors won't take responsibility for small things and fix attitudes. Killing whistleblowers is another problem. I would rather have a human doc who makes mistakes and learns from them and with me than one who thinks He is Christ. I've had both and the ego is more dangerous than all of them. The problem is really that the current "sue me/you" doesn't do anything to fix the true problems.
ReplyDeleteI wrote an extensive article for a print magazine that showed the doctors' side of malpractice. It's scary to what degree the cards are stacked against you guys, and many readers wrote in to say that they really never knew how much stress their doctors are under. A semi-retired surgeon that I interviewed had too many mind-blowing stories to include.
ReplyDeleteCan you please link to your article? Would love to read it.
DeleteSorry for the late response, I didn't see your comment. The article I wrote was for a print magazine with over 250,000 readers. There is no direct link to the article from their site, but you're welcome to email me for a pdf: michelle@medicalscrubscollection.com
DeleteAs PGYx said it is part of our culture. Instead of finding blame we should strive to fix a problem and get on with our lives. Alas, there are too many greedy people and lawyers (bottom feeders) for that to happen. I wonder if the overall effect on patient care is measurable?
ReplyDeleteFrom Aaron Carrol, MD at The Incidental Economist blog.
ReplyDeleteFor better or for worse, whenever many are asked about how they would help control spending in the US health-care system, tort reform always seems to be one of the first things offered as a solution. That’s because there’s a malpractice crisis! And tort reform will cure it! Except, neither of those things is really true. Watch and learn why not.
http://theincidentaleconomist.com/wordpress/healthcare-triage-malpractice-and-tort-reform/
...malpractice claims are incredibly uncommon. From the universe of people who could bring valid complaints of negligence, only two percent do; only a fraction of those result in payment, often through settlement.
...only about 2% of patients who suffer negligence bring claims. They’re outnumbered by claims that are frivolous or of uncertain merit (the gray area). Still, that means the number of claims filed is about 10% of what we’d see if every legitimately injured patient filed suit. And fewer than half of filed claims are paid—our current tort system sees malpractice payment for <0.05% of hospitalizations when 1% of hospitalizations could theoretically foster valid complaints.
In any medical encounter, there is a considerable chance of a disappointing outcome. However, most of these poor results are the unavoidable consequence of the disease itself and the inherent limits of medical science. Of all hospital admissions, only about 4 percent involve an injury caused by medical treatment. Of these, only about one-fourth (1 percent of the total) are the result of substandard care. Only about 2 percent of negligent injuries result in claims being filed with insurers. In part, this is because the great majority of these injuries are temporary or minor. Importantly, however, most claims are for injuries not caused by negligence.
http://theincidentaleconomist.com/wordpress/how-malpractice-reform-is-blown-way-out-of-proportion/