Gawande on US malpractice: "It’s a disaster"

Atul Gawande is interviewed by a newspaper in India:

Rule 1: Don’t do it the way it’s done in the US. It’s a disaster. Rule 2: If compensating for malpractice is deemed a priority, then a public fund should be established for people who have rare but serious complications from medical care due to error. Rule 3: Perfection is not possible in medicine, but our responsibility in medicine is to tell the truth about error, to measure occurrence, and to constantly work to reduce it.

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  • OB Doctor

    Maybe if politicians would read Gawande’s book, “Complications”, they might understand the nature of medicine a little better and be more interested in addressing the malpractice problem.

  • Kim Sanders-Fisher

    Medical Malpractice needs a complete overhaul in thinking. Malpractice cases should not be decided by ordinary Courts but by specialized Independent Medical Tribunals. The emphasis on penalizing mistakes and proving negligence needs to target cases of obvious negligent practice where Medical staff must be disciplined for unacceptable conduct. In other situations the investigation into a serious Medical error must focus on uncovering the causative problems or systemic flaws that can be avoided in future, so that similar incidents can be prevented. An expansion of the M&M, (Morbidity and Mortality), format used by Doctors would be a good thing.
    However, at the present time, all too often the blame for errors targets individual Medical staff while facilities indulge in perpetrating a systemically dangerous treatment environment with “Deliberate Negligent Understaffing.” Fewer staff mean fewer overheads and capping malpractice payout will just make this policy more financially viable. Hospitals are very rarely held accountable for creating unsafe conditions with exhausted, overstretched Nursing staff and poor hygiene from minimal, poorly trained cleaning staff. Government regulations on understaffing are patchy, badly monitored and wide open to corruption. There are strong financial incentives that guarantee Medical facilities will continue to cut corners with patient care.
    Fire insurance does not require you to prove that a certain person was responsible for causing the fire. Patients should be able to get insurance that covers just an adverse event or a poor medical outcome to their treatment. Informed consent on risk/benefit would mean a realistic acceptance of the cost both financial and otherwise. Such insurance should be jointly funded by the treating Medical facility and the patient receiving care. The reason for this is that both the Medical facility and the patient must be fully invested in working towards a positive outcome. I have elaborated on this concept in a post on my Blog Site, GO TO:
    http://medteam.wordpress.com/insurance-covering-medical-risk/
    This would provide a real financial incentive for Medical facilities to insure that their Nursing care was vigilant with appropriate Nurse to patient ratios; also that infection rates remained low and they did not skimp on cleaning staff. The patient would be duty bound to remain diligently compliant with the stipulations of their treatment as “noncompliance” is another major factor in poor outcome. Market driven variations in the cost of such insurance would encourage adequate staffing in Medical facilities and better compliance from patients. Ultimately we need to look at the real cause of the huge increase in Medical errors and the most obvious culprit is being totally ignored: “Deliberate Negligent Understaffing.” Please visit TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE to review the C.U.T! Campaign Goals to CONTROL UNDERSTAFFING TODAY: http://medteam.wordpress.com