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Re: heads up- malpractice insuranceFrom: Barbara Nicol MD (blnicol@ix.netcom.com)Sat Jan 26 20:51:22 2002
At Sat, 26 Jan 2002, Marilyn Ringst wrote: My whole point in all this is, I can speak from >professional experience when I say that there are geographic areas in the US >where ATLA is the only operant peer review and ACOG and many self-proclaimed >“leaders” in ob/gyn don’t give a damn. Medical Boards are ineffective and >the majority of ob/gyn’s who are good and competent are suffering for it. ATLA is not exactly "peer review". And malpractice suits are a poor substitute for real quality control. Most of the medical profession has a 1 in 10 or so chance of suit; 2 out of 3 OBs have been sued, and most of those more than once. I submit that this is not because we make more mistakes than our colleagues, it is because ob lawsuits pay better. Sad to say, but damaged babies are worth more to the trial lawyer than dead moms, especially if they didn't have a big salary, and worth way more than dead ICU patients, especially if they were over 70 or so. Is this the systematic, fair system of quality improvement we all want? I am not disputing that we have a long way to go in developing real quality control in medicine. Real quality control efforts will have to acknowledge that good, well-qualified, highly trained, hard-working practitioners make mistakes, because they are human beings. Because "good doctors" overwhelmingly outnumber "bad doctors", the majority of mistakes are likely made by "good doctors". (Yes, there will be a few "bad doctors" who actually do make more than their share of mistakes, and never try to improve, but I think that most of us on this list know from their own personal experience that those folks are the minority. Many times it is the "good doc" having a really bad day that makes a mistake.) Instead of pillorying the unlucky, as the malpractice suit so often does, we have to assume, as a profession, that we will inevitably make mistakes and create systems that help good-but-human doctors to avoid them. The legal profession is not helping us with this; trial lawyers actively hinder this process by punishing open discussion of medical errors and ways to prevent them. Certainly, there are closed, legally protected venues for quality improvement such as M&M and hospital quality boards. If anyone admits that his or her medical care might have been improved by such an event, that person is exposed to a potential lawsuit, which makes it rather difficult to explain to the public just how much quality review goes on every day in many hospitals. It also makes it difficult to share experience across institutional boundaries. I wish you would rethink your defense of ATLA. The tort system in this country does not provide an evenhanded or systematic approach to quality. If they were really primarily motivated by quality improvement, they would altruistically take suits where large financial rewards are not possible but real improvement in medical systems would be. Just being the "only operant review" does not make the malpractice suit a useful, systematic, speedy, just, or proportionate review. In my view, it has none of these characteristics, and for this reason needs urgent reform. Respectfully,
-- Barbara Nicol MD Everett WA USA
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