Doctors, hospitals, and their malpractice insurers like to demonize lawsuits brought by injured patients, but these legal actions provide a powerful way to identify problem practitioners, and the medical profession should see this truth and use it to better police its own ranks.
That’s one of the recommendations from medical-legal researchers at Stanford University, who examined more than a decade of 60,000 payments for malpractice claims against more than 50,000 doctors. They found a tiny slice of doctors rack up a disproportionate share of repeated malpractice claims. They describe these MDs as “frequent flyers,” a term familiar to the medical community because it often is applied to indigent and homeless patients who rack up big bills for repeated emergency room visits.
Profs. David Studdert and Michelle Melloound found that 2% of physicians accounted for 40% of the paid malpractice claims over a 13-year period. Further, in the report of their study in the New England Journal of Medicine, they offered details on doctors who lose, and keep losing, malpractice cases due to problem care:
Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims)
The researchers had new and mixed findings about what happened to doctors with paid malpractice claims. Some quit practicing. Most did not try to relocate to escape their marred records. This long has been a concern about regulators, especially because states control medical licensing. A national database was established to ensure that dangerous doctors didn’t move around and keep inflicting patient harms. But it has come under fire for its ineffectiveness.
In a “concerning” finding, the Stanford researchers reported that more than “90% of the physicians who racked up five or more paid claims in our study kept on practicing.” Frequent flyers, though, left larger physician groups and hospitals, choosing to join small practices or go solo.
That could be bad news for patients, as this means that they might have fewer colleagues around to see their work and to know if it may be problematic still. They also might not get to share information or get advice from other doctors.
The medical community, however, should heed the warnings that repeated malpractice payouts send about doctors, the researchers said, telling Stanford interviewers for a blog post by the law school:
Physicians often curse malpractice litigation for being random. While it’s true that not all medical malpractice claims signal poor-quality care, they are far from random. Repeated claims against a practitioner, in particular, are an important signal of patient safety risk. Regulators and the companies that provide physicians with liability insurance should be paying closer attention to this signal. We’re finding that the more we learn about these practitioners, the clearer that imperative becomes.
In my practice, I see not only the harms that patients suffer while seeking medical services, I and my colleagues get good looks at doctors, good and bad. Bad doctors get a lot of attention and do so much damage to their profession that it is hard to see why good MDs don’t root them out.
Here’s hoping that busting malpractice myths can help. As the Stanford researchers note, it isn’t random or rare bad luck that leads to the payout of medical malpractice claims. They take time and resources to make such cases and they can be stressful and hard on patients, so they aren’t pursued lightly. The Stanford findings add to growing evidence about frequent flyers, how medical malpractice suits can be an alert about their work, and the need for the profession to deal with them.