Malpractice payments at their lowest value since 1999

Fancy that, this trial lawyer-subsidized "non-profit" group has concluded that malpractice litigation hasn't increased health care costs... Did they consider that maybe the malpractice payments are down because they are losing the ludicrous cases that they litigate?

The amount of completely (medically) unindicated tests, procedures, hospital transfers and other costly services performed only due to the threat of litigation is difficult to measure. Nonetheless it is massive... Anyone who actually spends time on the frontlines working in the health care field is acutely aware of this. Many physicians reflexively order tests and "do more" to cover their asses because it isn't worth the time, headache and risk not to do so, even when the services are unnecessary...

Malpractice payments are down, but there is no evidence that malpractice itself is down. The Institute of Medicine estimates that there are almost 100,000 deaths a year from malpractice, but in 2009 there were only 3,537 malpractice payments in cases involving death of the patient. What is the real problem -- malpractice payments or malpractice?

We should stop trying to reduce malpractice payments as a goal in itself and start trying to reduce malpractice. Do that and the malpractice payment problem will take care of itself.

Only about 2 to 3 percent of physicians have been responsible for over half of all the malpractice payments since 1990. Doing something about the very few physicians who cause the bulk of the problem -- most of whom have had no action to revoke or restrict their license or clinical privileges -- would be a good start.

This conclusion is also in line with the Harvard Medical Practice Studies by Studdert at al. The vast majority of patients who are injured or killed by their medical care don't make claims; and plaintiffs are more likely to lose in jury trials.

Nobody knows the dollar figure attributable to "defensive medicine" because nobody has studied it. Most of the time doctors order more tests, studies, and procedures because they get paid for them, leading to 40%-60% overtreatment. For example, studies show that if doctors own outpatient surgical centers, their patients are more likely to have surgery. Practices are exempted from self-referral laws so they can recoup the cost of duplicative imaging technology. "Defensive medicine" or financial interest? Anecdote ("defensive medicine is massive", according to the poster above) is not data.

Atul Gawande's New Yorker article (June, 2009) about McAllen, Texas, showed that even in states with caps on payouts and where malpractice lawsuits are nearly zero, according to the doctors themselves, they still use the tired excuse about "trial lawyers" and "litigious patients" as their excuse for practicing the highest-cost medical care in the country.

If physicians and other clinicians practiced evidence-based medicine, patient-centered practices, and shared decision-making with their patients, there wouldn't be the anxiety-driven misapprehension to practice "defensive medicine." Maybe then doctors would view their patients as partners and not as adversaries.