3 Responses to “Opinion: Physicians May Be Slow to Change Behaviors, Even With Threat of Malpractice”

1. 

   April 5, 2015

   Rick Bukata Reply

   For what it’s worth I think Bill Gotthold, a long time acquaintance, is overly optimistic. The fear of law suits is so ingrained into the psyche of physicians (along with the general fear of making a mistake and its associated guilt and shame) that the practice of defensive medicine is not likely to be diminished – especially since law suits aren;t going away completely — so there is the opportunity for Pavlovian stimulation — random suits that are just as nasty as in the past.

2. 

   April 6, 2015

   Chuck Pilcher MD FACEP Reply

   As a recent study by the Harvard School of Public Health showed (1), the number one reason for patients to report a medical error is “so that this won’t happen to someone else.”

   So for decades plaintiff attorneys have been filing lawsuits claiming they do so “to teach doctors a lesson.”

   But we aren’t learning anything.

   Why? Because almost all lawsuits in which a settlement is paid settle CONFIDENTIALLY before trial. We docs are never allowed to learn from the experience of our colleagues. Attorneys are deluding themselves that lawsuits improve safety – except that they do increase the amount of testing, as Dr. Waxman and Gotthold point out.

   I am aware of 5 missed spinal epidural abscesses (SEA) in Washington State alone in the past 4 years. If only one of the many physicians involved in these cases – usually over the course of several days – had simply asked “Could the incontinence, radiculopathy, fever, pain, etc. be from an SEA?” every one of those patients could quickly have been diagnosed before they became paraplegic or died. That’s a travesty. If the physicians of each of those patients had known that SEA is a commonly missed diagnosis, it might have been more “top of mind.”

   Being transparent about settlements and sharing information with all physicians (like the Canadian Medical Protective Association (2) does) would do more to improve patient safety and reduce malpractice lawsuits than anything we’ve ever done in the field.

   There’s no excuse for this. We can do better. Check this out: (3)

   References:
   1. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2014/12/MA-Patient-Safety-Report-HORP.pdf
   2. https://www.cmpa-acpm.ca/home
   3. https://madmimi.com/s/324685

   • 

     April 12, 2015

     Louise B Andrew MD JD Reply

     I disagree with Chuck slightly in that I don’t believe plaintiff’s attorneys really believe (or are deluding themselves) that what they do is to improve safety. Except maybe Ralph Nader. Very clearly (it’s even stated up front in law school) what they aim and train to do is to make money from the misfortunes of others. The “improving safety” line just sounds very good to a prospective client and to a jury.

     However, I do agree with him that learning from our mistakes would be a good thing. Obviously he knows a lot about spinal epidural abscesses, something a typical emergency physician would not recognize too often in a career. Why not write an article based on these cases to help physicians not miss them?

     And though I am very impressed with the wide range of services offered by CMPA (look at the website and you will be impressed), I have not seen that they do a lot of publicizing of settled or litigated cases in the name of preventing future harm. Not saying that they don’t, I just don’t see it.

     Americans would be very impressed with the degree of protection offered by CMPA, and the relative safety of practice in Canada, without need to resort to much defensive medicine.

     But this is, in large measure, due to the non-litigious nature of Canadians relative to Americans (CMPA physicians are practically prohibited from treating Americans except in emergencies), and to the ferocious defense offered by CMPA to all of their insureds. I have heard plaintiff attorneys in private say “don’t bother suing a Canadian physician. You can’t win!”