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PUBLIC HEALTH
How Doctors Might Curb Malpractice ClaimsWith another big increase in malpractice insurance premiums slated for this year, physicians and patient advocates continue to debate whether malpractice law actually protects the public from sloppy medical care. The apparently random nature of malpractice claims has left many doctors feeling like the system is a crap shoot offering few strategies to cut the risk of being the target of an expensive, time-consuming, and upsetting lawsuit.
In a new epidemiological analysis of existing data on medical malpractice, HSPH faculty members Michelle Mello and David Hemenway uncovered a strong correlation between negligent care and a doctor's risk of being sued. (Photo by Leah Gourley) A new analysis of two large epidemiological studies on medical errors and malpractice leads HSPH researchers to conclude that the tendency of patients to sue is not as haphazard as doctors might think. Patients who are injured through a doctor's negligence are more than 20 times more likely to file a claim for compensation than are patients who are treated competently. "It's not totally random. There is a strong correlation between negligence of doctors and claiming behavior in patients," said Michelle Mello, assistant professor of health policy and law in the Department of Health Policy and Management at HSPH, who conducted the study with HSPH professor of health policy David Hemenway.
But there's a statistical twist. Since medical organizations incur many claims that do not involve negligence, cutting errors may not substantially reduce malpractice claims. An average care organization that reduces its error rate by half should see a reduction in claims of less than 10 percent, according to Mello and Hemenway's analysis, published in this July's Social Science and Medicine. So while the results indicate that risk of litigation may be more closely tied to errors than most doctors think, they also show that doctors and medical groups need to focus on strategies beyond error reduction to reduce their chances of being sued. The Logic of LawsuitsNumbers on the prevalence of medical errors and malpractice claims come mainly from two large studies carried out by Harvard researchers in the past 20 years. In them, doctors reviewed hospital charts on a total of more than 40,000 randomly selected patients to determine how many experienced injury, how many of those injuries could be blamed on negligence, and which patients filed malpractice claims. "They found very little overlap between the people who experienced negligence and the people who sued," said Mello. "The conclusion commonly drawn from these studies is that claiming is a random, haphazard process that can't be predicted and therefore gives no incentive for doctors to practice safely."It occurred to Mello and Hemenway that the 80 percent of claimants who did not actually suffer a negligent injury could be masking an association between malpractice claims and negligence, in much the same way that false positive diagnostic tests can cloud the epidemiological picture of a rare disease. Negligence is rare, occurring in one percent of hospitalizations. The researchers' analysis showed that while the injured one percent are 20 times more likely to sue than the other 99 percent, they are not 99 times more likely. The result is that most people who "screen positive," or bring claims, are false positives and not actual victims of malpractice. As a result, for doctors and organizations that make few errors, cutting errors even further would deflect only a small percentage of the total lawsuits the organization could expect to incur. "Doctors do care, and should care, about reducing injuries, but they shouldn't expect a huge ripple effect in the organizational claim rate," explained Mello. Honesty the Best PolicyFor error-prone providers, cleaning up their act would pay off more. A hypothetical group of providers Mello and Hemenway call the "bad apples," a group that makes five times more errors than average, could cut its overall claim rate by a quarter or more by halving its error rate.Reducing medical errors obviously has intrinsic ethical and patient care value, but Mello and Hemenway suggest that other strategies are important to reduce a doctor's risk of malpractice claims. Good communication limits claims, for example, since patients are less likely to sue a trusted clinician who deals honestly with adverse events (see related Research Brief). "Studies have shown that if a physician does not communicate well and treat the patient fairly," said Mello, "that is likely to provoke litigation." --Pat McCaffrey |
