Has medical malpractice changed medicine?

Professor of medicine, Washington University; Partner, Fox and Vuylsteke; President, St. Louis Metropolitan Medical Society

Professor of medicine, Washington University
Yes … ‘Safety movement’ and time-limited certification help safeguard patients.

Medical practice is fraught with complexity and uncertainty. Thus, medical malpractice is not defined by an unfortunate outcome or a patient’s death. Rather, medical malpractice refers to situations where patients are harmed because of mistreatment of a disease or injury through ignorance or carelessness.

Over the past decade a large number of physicians have been working hard to reduce malpractice by improving the safety and quality of medical care. One area of change has been the development of a “safety movement” in medical practice. The hallmark of this movement is the adaptation of a “systems analysis” of the care delivered by doctors and hospitals. Every process of care is scrutinized, even the tiniest detail, so that medical care can be made safer and more effective. One example of a recent “system change” is the marking of patients before surgery to avoid operating on the wrong side.

In addition, many specialty boards are now issuing time-limited certificates. For example, the internal medicine board now certifies physicians for 10 years rather than for life. Every decade an internist must pass an examination to maintain certification in the field. This policy represents more work for physicians, but most medical leaders feel that the resultant transparency and public trust warrant the effort.

One area where the profession needs to do better is in weeding out unfit physicians. Fewer than 5 percent of doctors account for more than 50 percent of malpractice suits. State boards are making progress detecting and expelling incompetent doctors, as well as drug abusers and insurance cheats, but more work needs to be done.

Since the time of Hippocrates, the ethic of medicine has been to “first do no harm.” In recent years the profession has responded vigorously to more closely approximate this ideal.

Partner, Fox and Vuylsteke
Yes … but profit shouldn’t trump the safety of patients.

Almost every person or business entity may be sued if they carelessly or negligently cause injury to someone. Because our society highly values medical professionals, they have been granted numerous protections above those enjoyed by the average person or business. Caps limiting non-economic damages, shortened time to file a lawsuit, and onerous pre-filing restrictions have all served to significantly reduce the number of medical malpractice claims.

Particularly affected are children, the elderly and the unemployed; including stay-at-home parents. These non-wage earners may be blinded, maimed or even carelessly allowed to die; yet their lives are worth no more than $350,000 under the recently enacted Missouri law. Given the prohibitively high cost of pursuing a medical malpractice claim, many of these patients and their survivors are being denied meaningful access to the civil justice system.

While the medical profession may applaud the resulting reduction in claims, we must face the moral issue of whether it is acceptable to value the life of wage-earners over other members of society.

As these restrictions play out in a medical marketplace increasingly controlled by large corporate interests, those concerned with patient safety find the trend toward devaluation of human life worrisome. Physicians believe in a creed, “To First Do No Harm.” However, just as the Securities and Exchange Commission must call “foul” on corporate malfeasance, so must the civil justice system seek to ensure that profit does not trump the safety of patients.

President, St. Louis Metropolitan Medical Society
Yes … and now maybe doctors now will return to underserved Missouri regions.

The threat of frivolous lawsuits has a chilling effect on all aspects of patient care. Patient access to “high risk” physician services is becoming more and more restricted. Obstetricians, neurosurgeons and other doctors have been leaving areas like Madison County, where lawsuit abuse is especially acute. They are retiring, or moving to regions with balanced liability systems that eliminate the jackpot-type mentality that has allowed plaintiff’s lawyers to become multimillionaires at the expense of patients and doctors.

Less visible, but more insidious, has been the voluntary restrictions that doctors have been forced to make. Many obstetricians have stopped delivering babies. Some surgeons no longer perform complicated surgery, or avoid doing essential surgery on patients at higher risk.

Most of the costs associated with professional liability do not go to injured patients. Much of the money goes to attorneys, but the greatest cost is for the practice of defensive medicine. Countless MRIs, blood tests, specialty doctor visits, diagnostic tests, unnecessary Caesarian sections, etc., are done primarily to reduce risk of lawsuits. These costs, estimated at over $100 billion per year, could be far better used to provide health care for the uninsured and improve overall quality of care.

Fortunately, there is light at the end of the tunnel. Professional liability reform in Missouri in 2006 stabilized premiums. This will hopefully see a return of doctors to underserved areas of Missouri as in Texas where record numbers of physicians have been relocating since reform was passed there in 2003.
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