It’s not that often that I agree with Mike Magee, the doctor who’s Health Politics is funded by Pfizer and tends to reflect big pharma’s viewpoints. But in his latest piece called The Road from Medical Malpractice to Safety: You Can’t Get There from Here, he lays out a convincing argument that the malpractice system directly impedes the goals of the patient safety movement. He states the core of this problem very succintly here:
- The American malpractice system, embedded in personal injury law, fundamentally undermines the patient safety movement. A head-to-head comparison tells the story. The tort system uses litigation as its lever for change. The safety movement uses quality improvement analysis. Tort law focuses on the individual. Safety focuses on the process. The tort system’s punitive and adversarial style drives information down, encouraging secrecy. The safety movement uses a non-punitive and collaborative approach, which encourages openness, transparency, and continuous improvement. With tort law, exposing oneself can end one’s career and harm one’s mental health. In the safety movement, contributing is career-enhancing and therapeutic. It may seem counterintuitive, but for medical malpractice to achieve its stated social purpose it must abandon the emphasis on a tort-based approach and embrace safety.
This has the massive implication that organized medicine’s proposed reforms to the medical malpractice system, particularly their desire for limits on pain and suffering awards, are irrelevant and counter-productive. Instead, the system needs to be replaced with a regulatory structure focused on patient safety. And by no means would that be a difficult transition for just the lawyers. It would be even more of a challenge for doctors, who would have to end what Mike Millenson has called “The Silence” of professional courtesy and expose themselves and their colleagues’ decisions to public review.
The AMA and the rest of organized medicine need to take the lead here, get off their high horse about the malpractice issue, and while they have a very sympathetic (i.e. Republican) Congress, develop some real bipartisan consensus on replacing the current tort system with a legally mandated patient safety system. That system will need real teeth to assure the public that it’s not biased in favor of physicians and providers. And of course we need a neutral public education campaign about why such a system is required; reason number one being that most malpractice currently goes on unimpeded, and this system will stop that.