Narmerguy

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http://economix.blogs.nytimes.com/2011/08/17/malpractice-anxiety/

I just think this is interesting how pronounced and consistent this is from when training begins.

Amitabh Chandra, a Harvard economist, is a leading expert on medical malpractice, and his work does not fit neatly into either the American Medical Association’s camp or the trial lawyers association’s camp. Sometimes it comforts one side. Sometimes, it comforts the other. I used Mr. Chandra’s research extensively in writing an overview of malpractice in 2009.

Now he and three other researchers have a new paper, published in The New England Journal of Medicine. Among its findings is that a large majority of malpractice claims do not lead to any payment from a doctor to a patient. Either the patient drops the case, or a court dismisses it.

In every medical specialty the researchers studied, at least three out of four claims led to no payment. In many specialties, about 9 out of 10 claims led to no payment.

Over all, about 7 percent of doctors faced a claim in a given year, and fewer than 2 percent made any payment relating to a claim.




These patterns, the authors note, may help explain why doctors’ concern over malpractice suits is very high even in states that limit such suits, like Texas. As the paper notes, doctors’ self-reported worries about malpractice vary little across states, even though malpractice laws vary greatly. The researchers write:

Our results may speak to why physicians consistently report concern over malpractice and the intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest. … Although these annual rates of paid claims are low, the annual and career risks of any malpractice claim are high, suggesting that the risk of being sued alone may create a tangible fear among physicians.

The perceived threat of malpractice among physicians may boil down to three factors: the risk of a claim, the probability of a claim leading to a payment, and the size of payment. Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.

These findings seem consistent with earlier research suggesting that malpractice reform is nothing like a magic bullet for high medical costs. But malpractice does weigh heavily enough on doctors’ minds that a more efficient accountability system for doctors — one in which avoidable errors were more likely to be punished and decent care was less likely to be subject to lawsuits — could both improve care and have some effect on costs.

In addition to Mr. Chandra, the paper’s authors are Anupam B. Jena, Seth Seabury and Darius Lakdawalla.
 

45408

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commenter at bottom said:
I'm a personal injury attorney and over the years I've handled approximately 90 medical malpractice cases. Of those, one was dismissed on summary judgment and two were lost at trial. The rest were successful
1. Bullsh-t. I bet all 88 of those clients don't agree with that claim.
2. How many patients were truly injured, but he just skipped over their case because it didn't have $$$$ written all over?

Our system has such dysfunctional incentives.
 
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Dral

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Derm is low...I like it. I'm surprised that Radiology and Path are so low. Without looking at the article, is it because it only counts physicians who are the primary defendant?
 

dilated

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It's kind of funny how the ED commonly busts out "medicolegal" or "we're under more of a microscope than you" as a "sorry I gotta get this BS consult" justification but they're actually getting sued (and losing!) even less than internists or neurologists, let alone high risk specialties. Or I suppose a cynic might suggest that's why.

Also interesting that GIs are so far up there. What are they getting missed for? Missing ca?
 

docB

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It's kind of funny how the ED commonly busts out "medicolegal" or "we're under more of a microscope than you" as a "sorry I gotta get this BS consult" justification but they're actually getting sued (and losing!) even less than internists or neurologists, let alone high risk specialties. Or I suppose a cynic might suggest that's why.

Also interesting that GIs are so far up there. What are they getting missed for? Missing ca?
It has not traditionally been the case that EM gets sued less than IM. If this article is correct then that shift represents a change.

I would suggest that a few factors could have led to this.

Our (EM's) "standards of care" have become more conservative over the years. We admit the vast majority of chest pain. All of the teaching about how you can't use response to a GI cocktail or one set of negative markers to distinguish cardiac pain from non cardiac pain was born out of lost suits. Missed MI has been and will likely continue to be the biggest money loser for EM.

There is little continuity in primary care and hospital medicine now. One thing that made EM a higher risk field was that we had no relationship with the patient compared to their PMD who they presumably knew for a long time and were more reluctant to sue. These days many urgent and even scheduled appointments are seen by whoever is available in the group. Hospitalists manage many admitted patients. So that relationship difference does not exist to the same degree it once did.
 
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