MDs get it wrong on medical malpractice, surgeon training

After four years of undergraduate education, four years of medical school, and then internships and residencies for several years after, doctors should be a well-informed lot, right? But they can get themselves into some downright dumb stuff. This includes their wrong thinking about the prevalence of medical malpractice litigation, and their head-scratching revisiting of a less stressful way to train tomorrow’s practitioners.

Contrary to conventional wisdom, new research has found that a relatively few number of physicians account for almost a third of medical malpractice claims paid. The researchers, examining more than 66,000 malpractice claims paid against 54,000 MDs nationwide between 2005 and 2014, said that just 6 percent of doctors had paid claims in the decade. Just 1 percent of physicians paid nearly a third of all claims. The researchers focused on paid claims as a marker of substandard care.

The MDs who had to pay out generally were older, internists, OB-gyns, general practitioners, or family medicine practitioners. As one news report on the study noted: “Each time a doctor got sued, the likelihood that he or she would be sued again went up.” Neurosurgeons, orthopedists, general surgeons, plastic surgeons and OB/GYNs were roughly twice as likely to have repeat settlements, as compared with internists, even after the researchers controlled for the inherent risk of practices like surgery, another news report on the study said.

The researchers said their work could help hospitals, medical groups, insurers, regulators, and patients start to better identify and deal with repeat offenders─doctors who are not taking on the most sick or highest risk patients but those with real problems and clearly in need of training, discipline, or more.  States and advocacy groups are creating publicly accessible databases to let patients research their doctors’ histories with malpractice claims.

Unfortunately, as I have experienced, physicians, medical boards, and professional groups are all too willing to look the other way and to shuck their responsibility to patients to deal with bad practitioners and bad practices. This often leaves the injured and aggrieved few options except the civil justice system. I recently pointed out colleagues’ work that shows that a mossy mythology has grown up around medical malpractice. This lets MDs, in particular, cling to their costly, inefficient use of defensive medicine. They say they so fear malpractice suits that they order up too many needless, costly, and harmful diagnostic tests and procedures; they move too slowly on innovation to improve care. This has got to stop.

Long hours for MDs in training

Some other recent research does little but ring alarm bells for me:  This effort purported to answer whether there are harms for surgeons in training if they work longer hours. After years of controversy, regulators stepped in and sought to cap the ridiculous hours that residents, surgical and otherwise, were expected to serve─not only to benefit aspiring doctors but more importantly to protect patients from harm from exhausted MDs. But medical educators and surgeons have pushed back on these limits. They say they are too strict. Some contend that routine 16-hour shifts, which also can stretch to 28-hour stints, are needed to prepare future surgeons to ensure they’re state-of-the-art with continunity of care and solid hand-offs of patients.

Some respected institutions participated in what was termed rigorous research. Others, however, blasted the work from its outset, saying elite institutions were, in violation of their own practices, using a couple hundred residents, and more importantly their patients, as human guinea pigs. Even after the study concluded, physician-experts were divided on its results: the published work says no harm, no foul in surgical residents’ long and longer hours; a contrary view found that one of the big sticking points─continunity of care and hand-offs─worked fine with shorter hours, so why change?

Physicians, heal thyself. As I wrote recently, students themselves have drawn damning portraits of the stress, cruelty, and harshness of medical training; MDs are reporting with greater frequency that they’re experiencing great stress and burn-out; the nation faces doctor shortages; and medical schools are revamping themselves and launching new institutions aimed at a different, better way to produce tomorrow’s caregivers. For their profession’s sake─and, for goodness’ sake, for patients’ well-being─doctors can’t keep crushing their young. We could feed our kids gruel and crusts, and force them to work Dicksensian hours in freezing, dangerous factories. We won’t. Why would we want to roll back reforms that prevent bleary, cranky MDs from treating sick and frightened patients?

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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