Tuesday, June 21, 2005

A cure for malpractice?

Neat stuff, kids.

In an age when malpractice insurance is through the roof, malpractice insurance for anesthesiologists is DOWN.

Why, you may ask?

Did they make some sort of deal with the trial lawyers?

Put a cap on lawsuits?

Nope. They decided to make fewer mistakes.

The anesthesiologists, once the riskiest doctors to insure, now pay some of the smallest malpractice claims in medicine because their professional association got everybody together and decided to work on the problem of patients dying. They developed new machines and new training methods to improve patient safety. Most impressive of all for a bunch of doctors (a profession, after all, known for its hubris) is that they started tracking mistakes and developed a huge database. Every dead patient and every lawsuit went in there until patterns and guidelines started to emerge. For example, they discovered a common problem was often inserting the breathing tube into the esophagus instead of into the windpipe. So the figured out a way around that.

Too cool, y’all, and an approach that every profession can emulate.



Jason Pitzl-Waters said...

A nice theory, and obviously all fields of medicine should strive to be the best they can be. But as the husband of a future doctor I can tell you that it is far more complex than simply doing the best job you can do.

For instance, malpractice insurance for OBGYNs is so high that few can afford to open a private practice or low-income clinics and most end up slaves to the indifferent hospital system.

Is this because OBGYNs are making tons of stupid mistakes? No, it is because our current health-care system in many cases binds the hands of good doctors to the whims of insurance statistics, HMOs, and hospital quotas.

Doctors should pay for their mistakes, but we need to also acknowledge that the current system of lawsuits, settlements, and indifferent medical corporations are a good part of the cause of these high malpractice rates.

These high rates punish the "good" doctors just as much as they punish the "bad" doctors. Malpractice insurance sadly isn't like car insurance, you don't get lower rates for avoiding accidents, and the story about the anesthesiologists while admirable doesn't one-to-one equate to all the other medical specialities.

If it was as simple as "stop f*&king up so much" it would have been done long ago, despite the famous doctoral hubris. If the current system continues you will see far fewer doctors going into "risky" fields of medicine.

The high death-rate is the direct cause of the de-humanizing system doctors work in today. Not due to some indifference to human suffering on the part of doctors.

Just my two cents.

Chalicechick said...

Well, I didn't mean to suggest that doctors were indifferent to human suffering. Easing suffering is, I assume, why lots of them went in to medicine in the first place.

That having been said, I'm not sure how HMOs and hospital quotas play into it other than people making mistakes under pressure and I'm pretty sure that insurance statistics come from people making mistakes.

And certainly I didn't mean to slam doctors as a whole. Some mistakes are very easy to make.

But getting together and coming up with safeguards, standards and procedures seems like a good way to avoid them. (e.g. for awhile at my job, we had a problem with invitations going to the printer with missing information. We solved it with a checklist. It wasn't one screwup messing things up. No individual person at my office left off a piece of information more than once, but the checklist has really solved the problem.)

Maybe I'm not understanding this issue well enough. How do HMOs lead to more malpractice claims if not by encouraging shoddy procedures that lead to mistakes?

Why would insurance work differently for anesthesiologists. Presumably some of them work for HMOs too, after all.

Please clue me in. I'm curious.


Jason Pitzl-Waters said...

First off, my lovely wife brings up a few of these issues/questions in a recent LJ post.

In fact, since much of my knowledge of this is second-hand I may just prod her into replying to your post! She would most likely be more lucid than I am (on this issue).

"some elsie" said...

i put in my second $0.02 right here.


why would it be different for anesthesiologists? it's probably not. as your article says, "Their annual inflation-adjusted premiums have climbed 24% since 2002." that's despite their immense cut in claims.

Psyton said...

hmmmm, I'll just take this as another indication of general practice falling back into the "esteemed profession" classification within my lifetime.

I would have preferred it to be law, but apparently no lawfirms have decided to become bargain-basement cheap yet have the quality to compete with the big-uns. I guess that's the issue with an industry as based on prestige and ballywho... or convincing former patients that it wasn't their over-eating or poor living that caused the suffering, it was the doctor who misdiagnosed it...