The Situationist

Posts Tagged ‘medical malpractice’

The Deeply Captured Situation of “Defensive Medicine”

Posted by The Situationist Staff on September 28, 2012

Sidney Shapiro, Thomas Owen McGarity, Nicholas Vidargas, and James Goodwin, have recently published their White Paper, titled “The Truth About Torts: Defensive Medicine and the Unsupported Case for Medical Malpractice ‘Reform’” on SSRN.  Here’s the abstract.

In the debate about health care reform, “defensive medicine” has become a convenient culprit for rising costs and especially rising physician malpractice premiums. Vaguely defined, the phrase, “defensive medicine,” is used to suggest that physicians make medical decisions to avoid potential litigation, instead of with their patients’ health and safety in mind. On the strength of this assertion alone, some policymakers argue for restricting Americans’ right to bring suit to recover damages for medical malpractice. This report demonstrates, however, that the proponents of medical malpractice “reform” lack persuasive evidence that tort litigation against physicians encourages them to make medical decisions that they would not have made otherwise.

Powerful business interests have compelling reasons to perpetuate the “defensive medicine” myth. Because the national health care debate has been framed around costs – not patient health and safety or access to care – the “defensive medicine” message has been successfully deployed to restrict Americans’ access to the courts in many states. Meanwhile, “defensive medicine” also serves as a politically expedient straw man, allowing policymakers and the insurance industry to ignore or obscure the real drivers of rising medical costs, including the high costs of prescription drugs; the high demand for, and increasing use of, state-of-the-art technology; the growing incidence of chronic diseases; and an aging population that lives longer and consumes more medical care.

This report first establishes that an intact and robust civil justice system is necessary to the health of society and exposes how rarely doctors are actually being sued. Next, it examines why doctors order tests and procedures. It then surveys available empirical evidence showing that a supposed “defensive medicine” mindset has little impact on medical decisions or on medical practice costs. The report also exposes extraordinary shortcomings in the methodology and academic rigor of the evidence most frequently cited by civil justice opponents.

The evidence reveals that “defensive medicine” is largely a myth, proffered by interests intent on limiting citizen access to the courts for deserving cases, leaving severely injured patients with no other recourse for obtaining the corrective justice they deserve. These changes would limit the deterrent effect of civil litigation and diminish the regulatory backstop that the civil justice system provides to the professional licensing system, leading to more medical errors. Restricting lawsuits might save doctors a negligible amount on malpractice premiums but the vast majority of any savings will most certainly line the pockets of the insurance companies demanding these restrictions. On the other hand, buying into this myth has very real and dangerous consequences. Allowing civil justice opponents to pretend that constraining the civil justice system equates to meaningful health care reform distracts us from doing the things that must be done to fix the system, including avoiding the 98,000 deaths caused by preventable medical errors every year and reducing the unacceptable number of uninsured Americans.

Download report for free here.

For a related recent briefing book assembled by the Center for Justice & Democracy click here

Related Situationist posts:

Posted in Abstracts, Deep Capture, Law, Politics | Tagged: , , , , , | Leave a Comment »

Doctors’ Conspiracy of Silence?

Posted by The Situationist Staff on July 25, 2010

From ABC News, here is the introduction to Kim Carollo’s article, “Many Doctors Reluctant to Report Inept or Impaired Colleagues”:

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Many professional medical organizations ethically require doctors to report other doctors who are incompetent or impaired by substance abuse or mental health problems, but as one recent survey found, more than a third of doctors don’t turn in their colleagues.

Researchers from Massachusetts General Hospital surveyed nearly 3,000 doctors across multiple specialties, and of the almost 2,000 who responded, 31 percent objected to the idea that they should have a responsibility to report physicians who are incompetent or impaired.

The survey also found that 17 percent of doctors had encountered an impaired or incompetent colleague over the past three years, but only two-thirds of them actually turned those doctors in. Only 69 percent of doctors said they know how to go about reporting a compromised colleague.

Lead study author Catherine DesRoches of the Mongan Institute for Health Policy at Massachusetts General Hospital told ABC News the fact that more than a third of physicians don’t agree that they have a responsibility to report doctors with problems is a “signifcant number” she finds troubling.

“Self-regulation is the primary mechanism we use to make sure doctors that shouldn’t be practicing are not practicing,” said DesRoches. “That’s a key to protecting patients.”

“This is a very important study, because it reminds us that we’re probably not doing what we should be doing,” said Dr. Virginia Hood, president-elect of the American College of Physicians and professor of medicine at The University of Vermont School of Medicine.

“Our primary responsibility is always patient safety and what’s in the best interest of the patient, and when it appears that we’re not doing what we should be doing, it’s a matter of great concern,” she added.

Doctors who are members of underrepresented minority groups, graduates of foreign medical schools and doctors in smaller practices were less likely to report an impaired or incompetent fellow doctor.

There were three main reasons many doctors did not turn in their colleagues.

“Twenty-three percent believed someone else was taking care of the problem, 15 percent didn’t think anything would happen and 12 percent feared retribution,” said DesRoches.

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To read the entire article, click here.  For a sample of related Situationist posts, see “The Situation of Bystanders,” “The Deeply Captured Situation of Medicine,” “Mistakes Were Made (but not by me),” “The Situational Effect of Groups,” “Stop that Thief! (or not),” The Situation of Prejudice: Us vs. Them? or Them Is Us?Racism Meets Groupism and Teamism,” “‘Us’ and ‘Them,’” “Four Failures of Deliberating Groups – Abstract,” and “Team-Interested Decision Making.”

Posted in Food and Drug Law, Morality | Tagged: , , , | 1 Comment »

 
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