Friday, April 01, 2005

inexplicable! inconceivable!

Kevin Drum looks at a new study that appears to show that actual malpractice costs have risen little over the past 15-20 years, and then says:
If doctors were smart, they'd team up with trial lawyers instead of fighting them. Together, they could probably agree on both genuine malpractice reform (as opposed to bogus and ineffective "caps") and insurance industry reform. Instead, they allow themselves to be suckered over and over again by insurance industry lobbyists. It's inexplicable.
It's not inexplicable to me, but then I have the advantage of growing up in a doctor's family and hearing his conversations with friends. They didn't view the rest of us as peers, at least with regards to medicine. We were simply not qualified to hold them to account. Lawyers, who as a group most often did so, were the enemy. Medicine was seen as an inexact art, bad outcomes as inevitable, and accountability as little better than second-guessing.

There are exceptions to this. Atul Gawande has written of the advances made in anesthesiology (death rates reduced from 1 in 5000 operations to 1 in 200000) that occurred when the speciality stopped viewing itself as a craft and began systematic efforts to reduce bad outcomes, in part due to financial pressure from malpractice claims. Anyone who's answered questions before a procedure ("How much alcohol do you consume? Do you use illegal drugs?") has seen the results. Dr. Gawande himself wasn't sure how to apply the same process to a field like surgery, but as long as doctors oppose systematic data collection for fear of adverse personal consequences, the data needed to drive the process won't even exist.

In some ways, I'm quite sympathetic to the doctors' view. Medicine is an inexact science, and tort law a terrible mechanism for addressing inevitable bad outcomes. When such outcomes occur, however, someone has to clean up the mess--pay for additional medical care, support the medically indigent and their dependents, etc. Without better alternatives, lawsuits are inevitable, and I don't see doctors leading the search those alternatives.

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