Replies

I read the IOM study when it first came out. From what I recall, all medical errors were lumped together and no effort was made to try to assess whether there was medical malpractice in the legal sense. The methodology of the study tended to under estimate the rate of error and has withstood challenge.

Some medical specialties invite litigation because they involve high stakes and difficult judgment calls. Brain surgery, Ob-Gyn, and orthopedic surgey all frequently require decisions with the potential to cripple or kill that is lacking in specialties such as dermatology or family practice.

Doctors often fantasize about a no fault compensation scheme for "bad outcomes." But such a mechanism is implausible because it would soon become like workmen's comp with high premiums, frequent but paltry awards, and its own burdens of administrative and legal costs. Since the number of prospective claimants would be far more numerous than doctors, they will tend to win the political battles that shape any such system.

Actually, the medical profession seems to be moving toward more vigorous efforts to reduce or eliminate errors and to be more forthcoming with patients. Anesthesiologists were nearly put out of business by high malpractice premiums but eventually revised their equipment and procedures so as to eliminate many sources of error. Consequently, they now have one of the best malpractice records and low insurance premiums to match.

The combination of high malpractice premiums, evidence based medicine, cost control, and quality measurement will bear fruit over time. The best course for the medical profession is to pursue such reforms rather than to try to tilt the legal system in their favor. When the chips are down, the public fears being the victim of medical malpractice more than they fear death or sympathize with doctors over high malpractice premiums. Doctors almost always lose when malpractice issues get to the ballot box.

The changes made in anesthesiology were to better record and document the safe way that they practice so as to avoid the situation where, in the case of a maloccurrence, the plaintiffs attorney would make a charge that a particular aspect of the case wasn't managed correctly and the anesthesiologist would have nothing on the chart to refute the charge. The change was in monitoring and documentation for medicolegal self defense, NOT a change in care.