Leisure Guy, one of my most faithful commenters, opines that I am omitting an important aspect of the tort reform argument. He has implored me repeatedly to read a particular book that I suspect buttresses his views, but this worthy pursuit is simply not near the top of my priority pyramid. Since he’s retired, he enjoys the luxury of burrowing deeply into the base of his priority pyramid. With 4 tuitions to go, retirement is a distant mirage for me. I’m can be a ‘leisure guy’, but only in my dreams.
I have written throughout this blog and elsewhere that there are too many frivolous lawsuits against physicians. I have admitted that caps on non-economic damages are not ideal, because they deny some worthy plaintiffs of complete compensation, but I support them because I believe they serve the greater good. I have ranted that there is no effective filter to screen out physicians who should never be invited to the litigation party in the first place. I believe that the current liability system encourages the practice of defensive medicine, which wastes billions of health care dollars and exposes patients to unnecessary risk and expense. I believe that the system is unfair and needs to be reformed. I stand by these views.
Leisure Guy (LG), in between sipping piña coladas on his deck, sent me a personal e-mail. Here’s his correspondence in its entirety.
It does seem that, given the goal of reducing the number of lawsuits for medical malpractice, the simplest, most direct, and most effective action is preventing incompetent MDs from practicing, regardless of the source of the incompetence (alcoholism or other drug dependency, dementia, and so on). In fact, it would seem to me that this is much more obviously a course of action than going after lawyers and tort reform: stop the malpractice, and the lawsuits will stop. (That was the experience of anesthesiologists.) But you continue to focus on lawyers and the courts, and I’ve never read a post in which you go after the MDs for protecting incompetents and keeping them in practice---that seems inexplicable.MDWhistleblower is not like the Sunday evening CBS news program 60 Minutes, where an unsuspecting guest is accosted by a journalist who intends to humiliate the individual publicly and irrevocably. In contrast, I have come not to bury LG, but to praise him. He has an important point that merits inclusion in the tort reform conversation. Is it fair for physicians like me to rail against the unfair medical liability system, while we remain mute about medical negligence? No, it is not.
Reading plaintiff lawyers’ blogs, one would think that medical incompetence is spreading across the medical landscape like a wildfire. We read the ubiquitous assertion that there are 98,000 preventable deaths every year, a statistic that is trying through repetition to become transformed into a fact. In my 20 year career, I have only occasionally witnessed medical negligence. I certainly see and participate in plenty of adverse outcomes. I see every day colleagues who make medical judgments that differ from my own. I am informed by patients about physicians who lack important communication skills and would benefit from a week’s retreat at Doctor Charm School. I see on occasion physicians who are rude to nurses. I regularly see physicians who, along with patients, over utilize medical testing and treatment. I see too often physicians who order medical tests for the wrong reasons.
In some of the above cases, the physician is me.
None of these examples, however, represent negligence. If there is an epidemic of medical incompetence, it either doesn’t exist in my world in northeast Ohio, or I am too incompetent to recognize it. I am interested in the views of other physician readers on this issue. How much true medical negligence and incompetence do you witness?
Nevertheless, my friend LG correctly points out that we physicians are not effective or serious at holding our members accountable. Sure, every state has a medical board, but we all know how egregious an offense must be to result in a serious professional sanction. It is not part of medical culture to identify colleagues who have demonstrated competency lapses, committed a negligent act or may be impaired. Recall the adage, ‘friends don’t let friends drive drunk’. Physicians don’t turn in colleagues who may be in need of remediation and rehabilitation, except in extreme circumstances. What stops us? Are we scared that we will be stigmatized as a squealer and ostracized? Do we rationalize that we might not know all the facts about a practitioner who may appear to be missing the mark? Do we look the other way hoping that some other corrective mechanism will descend from the sky to address the issue? Do we allow our empathy for a fellow colleague to corrupt our judgment? .
I don’t retract a single syllable of my views on the need for tort reform. But, we physicians should also heal ourselves. This is our professional obligation and would also deepen the trust between us and the patients we serve. Not only is it the right thing to do,but it's a smart move also. Haven’t we learned over and over again what happens when we don’t act proactively to solve a problem? The White Coat Wall of Silence will become yet another target for 'reformers' to shoot at. Let's take this target off the field.