Most Doctors Will Face Malpractice Claims During Their Careers
WEDNESDAY, Aug. 17 -- About three-quarters of U.S. doctors will be sued for malpractice at some point in their careers, though the vast majority will not end up paying any claims, a new study suggests.
The researchers, saying their analysis is the most comprehensive of its type in more than 20 years, found that surgeons faced the highest chance of having a malpractice claim filed against them, while specialties with the lowest risk of a lawsuit included family medicine, pediatrics and psychiatry.
Only about 20 percent of all claims actually led to a payment, and the specialties most likely to face lawsuits weren't always most likely to pay claims, according to the study, which is published Aug. 18 in the New England Journal of Medicine.
"I think the option to sue your doctor if he's done harm to you is an important patient right, but this research suggests it's a right that can be overused in some settings," said Dr. Jay Bhattacharya, an associate professor of medicine at Stanford University and core faculty member at Stanford Health Policy, who wasn't involved in the study. "Lawsuits aren't necessarily indicators that the doctors being sued are in the wrong."
During each year of the study period, 7.4 percent of all physicians had a claim filed against them, but only 1.6 percent made a malpractice payment, the study said. In any given year, about 19 percent of thoracic surgeons, neurosurgeons and cardiovascular surgeons could expect to be sued, along with 15.3 percent of general surgeons.
The average claim payment was about $275,000, and the cumulative career risk of facing a malpractice claim was 99 percent in high-risk specialties and 75 percent in lower-risk ones.
Amitabh Chandra, the study's corresponding author and a professor of public policy at Harvard Kennedy School, said surgeons are sued most often because their procedures inherently involve a great deal of risk and can produce disastrous results regardless of a surgeon's skill or competence.
"Juries are able to see this some of the time, but not all," Chandra said, adding that "hassle costs," such as anxiety and court time, add to physicians' burden in facing unwarranted suits. "I now understand why doctors are so upset with the malpractice system. They're worn down."
Chandra and his colleagues, who came from Massachusetts General Hospital, the University of Southern California and the RAND Corp., analyzed claims spanning 1991 to 2005 from a major malpractice insurer operating in all 50 states and the District of Columbia. Data reflected more than 230,000 physician-years of coverage involving nearly 41,000 doctors.
Chandra and Bhattacharya disagreed whether the specter of malpractice suits caused doctors to practice so-called defensive medicine, prompting them to order more tests or procedures for patients out of fear of potential claims.
"On one hand, there's no question doctors are being sued extremely often," Chandra said. "It's also clear to me that defensive medicine is not as big a factor as doctors claim."
Bhattacharya, however, contended that defensive medicine contributes to the larger problem of excessive medical costs.
"You can tell yourself it's good medicine, but on the other hand, we're facing the problem of very high health care expenses," he said. "While I don't believe it's a major contributor to high health care costs, I do believe it is a contributor."
Chandra asserted that establishing "no-fault funds" to compensate patients and families in unavoidable situations, such as birth injuries, would be one of the ways to fix the dysfunctional malpractice system. Laws that establish caps or limits on the maximum amount patients can recover in malpractice suits are popular among doctors, he said, but aren't necessarily a sound idea.
"Damage caps don't reduce the frequency of awards," Chandra said. "It's a badge of professional solidarity that doctors band around caps, but I think that's completely the wrong approach."
Both experts agreed that cultural expectations need to change for true reform to happen in the malpractice system.
"We have to learn to accept that a bad outcome isn't always caused by a doctor," Bhattacharya said. "I don't see a quick fix for this."
"I think the study is very interesting," he added. "It says all kinds of things about how well our medical system is running, how patients respond to failed medicine and how well doctors respond to not being trusted. It's better than any data I've seen in a long time on this topic."
Posted: August 2011