An interesting strategy for dealing with Med-Mal

The Wall Street Journal (?) took a look at how Anesthesiologist addressed their high medical malpractice insurance rates over the past twenty years.

Anesthesiologists pay less for malpractice insurance today, in constant dollars, than they did 20 years ago. That's mainly because some anesthesiologists chose a path many doctors in other specialties did not. Rather than pushing for laws that would protect them against patient lawsuits, these anesthesiologists focused on improving patient safety. Their theory: Less harm to patients would mean fewer lawsuits.

There has been a nice little side-effect from their efforts.

Over the past two decades, patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies, a leading scientific advisory body.

The article talks about other specialties, like the American College of Surgeons, are starting to follow the anesthesiologists lead in studying closed insurance claims in order to understand how poor outcomes occur.

Dr. Griffen of the College of Surgeons says that more surgeons have begun to see a connection between improving patient safety and lowering malpractice premiums. The college's closed-claims study so far involves about 350 cases, and the group hopes it will grow to 500 this year.

At the University of Utah Hospitals and Clinics, Dr. Kochenour says his institution has tried to emulate the anesthesiologists by concentrating more on identifying systemic errors and less on individual blame. But these efforts run headlong into thinking drummed into physicians since medical school, he says. "I don't think physicians are very good systems thinkers, by and large," he says. Many, especially surgeons, prize their independence, he says, and that makes it hard to achieve the kind of cooperation necessary to reduce errors.

I wonder if other medical specialties will be able to make similar improvements as the anesthesiologists. I don't know if other physicians are making mistakes of the same magnitude that anesthesiologists were 20 years ago. If not, then they would not have the room to make such dramatic improvement.

I wonder if the comments about physicians not being good system thinkers sheds some light on why they have taken the political position to focus on caps as the most important part of tort reform. This focus, I believe, largely comes from the fear of what could happen to them as an individual if they were saddled with an outrageous jury award. This is perfectly understandable. Unfortunately, they do not think as much about how caps would lead to more harm for patients across the board. Taking a more systematic approach to the problems of med-mal, as the anesthesiologists did, would protect both conscientious physicians and patients.