Malpractice Reform: is a new paradigm needed?
If you read my previous post on some of the tough issues that doctors and patients face when dealing with clinical ambiguity and potential for malpractice, you can begin to appreciate some of the difficulties in addressing these issues. We know there are many reasons patients sue, and many have nothing to do with negligence. Some are related to their feelings about a “bad outcome.” We also know that many “bad outcomes” are part of the unavoidable risk of some treatments. Using my previous example of joint replacement surgery, we know that even when the treatment protocol follows the scientific literature by the book, about 1/100 joint replacement patients will sustain a blood clot to the lung in their post operative course.
I think there are at least 2 remedies to the malpractice problem: one local and one systemic.
1) The physician must be aware that ANY bad outcome regardless of whether “standard of care” was followed may evoke severe emotional distress in a patient. In these cases the physician must endeavor to strengthen the doctor patient relationship and address the emotional needs of the patient as well as attend to the physical complication.
2) The systemic solution is to realign the system in a way that better reflects the reality of risk.
A better system would integrate two types of insurance: “malpractice” insurance- purchased by the physician and “bad outcome” insurance - purchased by the patient. A “bad outcome” market would address the unavoidable: the risk that a patient could sustain a complication or less than desirable outcome, even after the absolute standard of care had been followed. It would be akin to insuring a trip to the Caribbean against a low risk but detrimental event such as a hurricane. One of the hard things about medicine is explaining to patients that you can never eliminate 100% of the risk inherent to treatments. Such a market would not only be possible but would communicate a more realistic view of risk of medical interventions.
