How Doctors Can Reduce Medical Errors, Lawsuits

January 19, 2012- Kevin Pho, MD, America’s number #1 physician blogger, wrote the following column for USA Today on January 18, 2012.

Kevin is a New Hampshire internist who was in the physician blogging scene in its early stages. His blog contains not only his blogs, but those of many other physician bloggers, including me. Today, for example, he ran my recent blog on "Hos Hosptials Are Gaining Leverage over Physicians."

By running other physicians blogs,Kevin follows the unwritten code of physician bloggers: Thou shall support and highlight the work of your fellow physician bloggers.

Here Kevin captures and aptly describes the fear of most physicians – an unjustified malpractice law suit.

Ask doctors what concerns them most, and chances are they'll say, "medical malpractice." A recent New England Journal of Medicine study found that 75% of doctors who practice psychiatry, pediatrics or family medicine will be sued during their career. Neurosurgeons, orthopedic surgeons and obstetricians have it worse, as virtually all of them will be sued before they finish practicing medicine.

The medical malpractice debate often pits physicians — who say the threat of lawsuits pushes them to order expensive, unnecessary tests — against lawyers who believe that lawsuits are needed to hold doctors accountable.
Obviously, no one wants medical mistakes. And no one, perhaps with the exception of lawyers, wants lawsuits, which put the victims, their families and the doctors involved through wrenching affairs.

How can physicians avoid the courtroom? If an error was made, many insurers advise physicians not to talk to patients. That's wrong. Physicians should disclose their mistake, apologize and, when appropriate and through mutual agreement, compensate injured patients.

Apology Laws

For more than a decade, the University of Michigan Health System has used such a program, and its incidence of malpractice claims has since dropped 36%.

This approach should be spread nationwide. Actually, in 2005, then-Sens. Hillary Clinton and Barack Obama co-sponsored the National MEDiC Act, which among other things would have implemented apology laws throughout the U.S.

Although the measure never became law, at least 36 states have passed legislation protecting apologies from being used against doctors in court.
Doctors also must create and maintain open lines of communication with patients, which is critical to preventing lawsuits in the first place.

Doctors have to better explain, and patients better understand, that not all adverse outcomes are due to physician errors. Although the Institute of Medicine's 1999 seminal report, "To Err is Human," concluded that medical errors caused up to 100,000 patient deaths a year, 90% of those deaths were attributed to systemwide procedural failures at medical institutions.

Nothing's Easy

Consider the seemingly simple task of dispensing a drug at a hospital. It's actually a complex process that requires five interdependent steps: ordering, transcribing, dispensing, delivering and administering. A poorly designed system can lead to an error in any of those steps, with a potentially deadly outcome. Bad outcomes can also occur despite proper patient care. A colonoscopy can be performed correctly, for instance, yet complications such as a bleed or a tear in the colon can still unexpectedly occur.

Finally, fewer lawsuits might lead to better medical treatment. A 2011 study from the Journal of the American College of Surgeons found that doctors who had been sued were more prone to burnout, depression and suicide, and, in turn, often make significantly more mistakes.
There's no panacea for eliminating mistakes, but a starting point is clearly communication. Better doctor-patient exchanges improve medicine, and when patients and their families are kept in the loop, they also are less likely to pursue a lawsuit. And, then, if errors are made, doctors should apologize and work with the patient and, when necessary, their lawyer, to find a compromise.

Tweet: Transparency is the key to an open, trusting and healthy doctor-patient relationship.