Bad things can happen to good doctors-and their patients

November 19, 2010

Practicing good medicine can be a delicate balancing act that includes clinical skills and knowledge, the application of the skills and knowledge, and often, patient adherence (depending on what's being treated).

Unfortunately, even the most competent clinicians who are skilled diagnosticians and who adeptly apply the most current, evidence-based clinical protocols may experience negative patient outcomes.

That's where societal issues may collide with doing the right thing. It seems that we live in a culture in which there are people, including some healthcare consumers, who don't want to accept that negative outcomes can occur even when everything is done right. They may not want to accept that sometimes, terrible things just happen.

Medical liability system costs in the United States are an estimated $55.6 billion (in 2008 dollars) annually, with $45.6 billion of that total potentially attributable to defensive medicine-related spending by physicians and at hospitals, according to an analysis in the September issue of Health Affairs.

Although some states, such as Texas, already have enacted medical malpractice tort reform, much has been said about the need for reform on a national level.

That's where a novel idea comes in that has been suggested by Peter Orszag, director of the White House Office of Management and Budget from 2009 to 2010. Orszag says in an October 20 editorial in The New York Times that tort reform, rather than focusing on caps on liability, instead should be aimed at creating a "safe harbor" or "malpractice immunity" for doctors who follow evidence-based guidelines. He points out that evidence-based guidelines aren't always established in certain areas, but when they do exist, research suggests that they are only followed about half the time.

The healthcare reform legislation passed earlier this year, Orszag says, includes funding for some state pilot projects-including one in Oregon with $300,000 in funding that is focused on testing this approach.

However, Orszag says that: "What's needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That's the only way that malpractice reform could broadly promote the adoption of best practices."

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