Tuesday, July 11, 2006

Medical malpractice

This Slate article argues that the increase in medical malpractice awards and insurance is driven by actual errors and real harm done to the patient, not juries awarding crazy amounts to plaintiffs.

If so, medical malpractice jury awards are bucking the trend -- when NYC made jury duty mandatory, and juries became comprised of normal New Yorkers, not just the poor (who were more likely to want to give money from rich to poor, no matter where the fault lay), the found that awards dropped sharply (cannot find New Yorker article that had this).

While Slate says the Democrat's plan for giving money to hospitals so they can analyze their law suits and reduce error is a good one, I'm not sure why hospitals do not already have all the incentive they need to work hard at rooting out medical error. After all, hospitals pay dearly for legal council and malpractice insurance already and want to keep their patients alive. Why aren't they focused on reducing error already? And if they don't care about reducing error now, why will tax payer money make them more likely to do so?

One idea is that malpractice insurance is mostly paid by doctors through foregone wages, and any monetary benefits from reductions in errors will accrue to the physician, not the hospital. But individual physicians do not have the ability to coordinate across multiple units in a hospital and reduce error, so the improvements never happen.

Another idea is that physicians are simply not comfortable with admitting to error, which goes to the heart of how to reduce it. There are another New Yorker article that says autopsies are no longer performed in the US, because physicians will not admit to error. Certainly medical culture makes it hard to admit being wrong, and there is the fear that if you admit you made a mistake, you may get sued.

Lastly, by and large medical research does not focus on process. The ER is the most process focused department in the hospital, and their research rarely looks at systematic causes, and fixes, for errors, it focuses on what the best treatment is. Physicians, when they do research at all, do medical research, not operations research.

I don't see how tax payer money will change any of the above though. Capping medical malpractice may make doctors and hospitals more open to admitting and researching mistakes (because they are no longer afraid they will be sued to pieces), but I think that's a weak argument too.


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