Legal Medicine

One chapter in Atul Gawande's Better addresses medical malpractice. I don't know much about medical malpractice, but I will. Most doctors face some sort of litigation against them in their careers. "The average doctor in a high-risk practice like surgery or obstetrics is sued about once every six years. Seventy percent of the time, the suit is either dropped by the plaintiff or won by the doctor in court. But the cost of defense is high, and when doctors lose, the average jury verdict is half a million dollars." I found this chapter fascinating. Gawande interviews a doctor who became a malpractice lawyer, and the lawyer's attitude is striking. He takes only cases he can win and only cases that offer him a substantial monetary reward. This makes sense from the lawyer's point of view, but it serves the lawyers, not patients or doctors. The stakes are high, and lawsuits attempt to cherry pick the most lucrative cases. The system does not work; "ninety-eight percent of American families that are hurt by medical errors don't sue. They are unable to find lawyers who think they would make good plaintiffs, or they are simply too daunted [...] In the end, fewer than one in a hundred deserving families receive any money. The rest get nothing: no help, not even an apology." Indeed, because of fear of litigation, doctors do not apologize for errors and play defensive medicine, running unnecessary tests to protect themselves. This is not a climate conducive to efficient or effective patient care. Furthermore, lawsuits ruin doctor's careers. Many times, insurance companies will have doctors settle even if they did nothing wrong because it is cheaper to settle than to take the case to court. Even if doctors are exonerated from blame, there is a huge psychological hit. The antagonistic, adversarial nature of medical malpractice needs to be fixed. In my mind, we need a system that does three things: compensates a patient for damages due to a physician's negligence, acts as a safeguard to prevent grossly negligent doctors from practicing (licensing boards are the current mechanism), and is an economically sustainable structure that prioritizes doctor-patient relationships.