Friday, August 7, 2009

Column in Today's News and Observer

Today's column in the News and Observer is on malpractice reform, and its role in helping develop a consensus reform plan. I focus not only on some policies related to malpractice, but the fact that I see this issue as key to get doctors on board and engaged in a changed system that has a hope of reducing cost inflation. Some additional reading resources if you are interested:

*My colleagues from Duke, Frank Sloan and Lindsey Chepke have a book Medical Malpractice, published in 2008 by MIT Press. Very detailed discussion of the policy options regarding dealing with malpractice.

*Several key papers that form the background of what is in the article, much of it published by David Studdert, Michelle Mello and Troyen Brennan.

**2006 paper in New England Journal of Medicine that is the source of the finding that 4 in 10 lawsuits filed did not have an error in care provided.

**2004 paper in the New England Journal of Medicine that provides a comprehensive overview of the literature, including the finding that only 2% of all true negligence results in a lawsuit.

**2003 paper in the New England Journal of Medicine that has a nice historical discussion of the cyclical nature of the malpractice insurance premium crisis, including the factors that have nothing to do with actual claims experience.

*Institute of Medicine report from 1999 To Err is Human, altered the discussion away from only being on focused on a malpractice crisis, and to there being a patient safety/quality crisis. This report estimated that 44,000-98,000 persons died of medical errors annually, which would make it the 7th leading cause of death in the U.S. Update of this report from May, 2009 is here, published by the Safe Patient Project, an effort of the Consumers Union. Here is someone saying the IOM overstated deaths due to errors. Even if they were off by a factor of 10, then that is still about 25 people per day dying due to medical errors in the US.

*The Harvard Medical Practice Study has produced many papers over the past 17 or 18 years on the topic of malpractice. This is a key study because it had completely overlapping data on the legal system and the medical system. Probably the most important paper from this study is here (original source of 2% of negligence resulting in a claim) with a reprint of it here. There are many others.


  1. The article in N and O was one of the most succinct perceptive pieces of writing on health reform I read. Doctors should lead the way. And if medicine can become a profession and, as you put it, a "calling" once again, patients will be the prime beneficiaries. Thanks!

  2. Excellent points. Dr. Jeff Segal, CEO of Medical Justice, was on Lou Dobbs last night, debating a trail attorney on liability reform. Dr. Segal made many of your same points regarding defensive medicine.

  3. As usual a comprehensive and well-written article.

    In addition, wouldn't one of the many options suggested for a national committee that would decide evidence-based practices also lessen the likelihood of a suit by showing that the physician had acted properly in using best practices? On the other hand, if the physician had strayed from best practices, this would weaken the defense and result in an early settlelment.

    Jim Coughlin