The emotional costs of malpractice mean more to doctors than money

The emotional costs of malpractice mean more to doctors than moneyEvery year, according to a recent study from the New England Journal of Medicine, a typical physician has about a 7% chance of being sued for medical malpractice.

Surgeons almost certainly will face a malpractice claim sometime during their career.  Neurosurgeons, for instance, have a 19.1% chance of being sued in a given year, while that number is 18.9% for thoracic and cardiovascular surgeons and 15.3% for general surgeons.

Major media outlets, like the New York Times and the Wall Street Journal have seized upon the fact that only 20% of these malpractice claims resulted in payment.  So, doctors shouldn’t worry, right?

Well, no.

It is true that the majority of malpractice cases are decided in favor of the physician, but consider that, according to an earlier New England Journal of Medicine study, almost 40% of malpractice claims did not involve any medical error.  That suggests doctors are not infrequently involved in the malpractice process even when they didn’t make a mistake.

A malpractice suit is tremendously disruptive for doctors, and is something to be avoided at all costs.  Being sued is associated with a higher rate of suicide and the emotional scars sustained during a lawsuit stay with doctors forever. Some physicians compare the stress of a malpractice trial to facing death:

Surviving a lawsuit is akin to overcoming a death, said Dr. Firestone, the California psychiatrist and attorney. Doctors go through phases of denial, grief and acceptance. “[The impact] varies from individual from individual, but it could last a lifetime,” he said.

And these indirect costs of a lawsuit aren’t covered by malpractice insurance, according to the NEJM study:

Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.

So while the actual financial risk most doctors face during a malpractice case is relatively low, the probability of being sued is high, at over 7% annually.  Even if a case is settled, or if the doctor wins in court, the physician sustains a tremendous amount of emotional damage.  It’s no wonder that most would want to avoid that experience at all costs, and wouldn’t hesitate resorting to “defensive medicine” in order to do so.

Instead, I continue to argue for a non-adversarial malpractice system — a no-fault system that Sweden uses, for instance — which would compensate  injured patients quicker and encourage open discussion of medical errors, while sparing innocent physicians the ordeal of an emotionally draining malpractice experience.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • James deMaine

    Our medical group sponsored a course called “You are Summoned” put on by a group of lawyers and physicians.  This may have helped  us to at least learn the mechanics of depositions, lawsuits, and how lawyers and plaintiffs think.  But I’d agree a lawsuit can be hurtful, isolating, and produces a sense of guilt and/or anger.  We used a “buddy system” for supporting sued physicians, the mentor being a doc who’s “been there.”

    These measures may help mitigate the emotional damage that occurs, but we need to get out of the tort system to handle damages.  I doubt the lawyers want much change.  The plaintiffs’ attorney is looking for the “home run” while the defense attorney can happily bill by the hour.  If we wanted to design an inefficient costly system, we’ve got it.

  • http://twitter.com/phlu Ross D. Silverman

    Two thoughts arise for me while reading your post –

    1) “Almost 40% of claims did not involve any medical error” — True but
    incomplete. In almost all of those cases, there was an injury to the
    patient (e.g., unavoidable or potential risks/side effects). In many
    cases, claims are filed, and then ultimately dropped, to get answers
    about what happened during care. Remember the case of Dr. Bill Franklin
    from Gawande’s “The Malpractice Mess”? As Gawande put it then: “Here’s
    where we in medicine has failed. When something bad happens in the
    course of care and a patient and family want to know whether it was
    unavoidable or due to a terrible mistake, where are they to turn? Most
    people turn first to the doctors involved. But what if they aren’t very
    responsive, or their explanations don’t sound quite right? People often
    call an attorney just to get help in finding out what happened.” How
    much better have we in medicine gotten about sharing this information
    since that piece was published 6 years ago? Or about truly informed
    consent for patients, so they can best understand the limits (and
    dangers) of what might be able to be achieved for them through medical
    interventions?

    Furthermore, you also left out that, for every case filed, there are 8
    more
    incidents of negligence occurring in hospitals that do not lead to
    lawsuits. In other words, the ratio of negligent acts in medicine to
    lawsuits filed where there was no error is actually closer to 2000:1.

    2) I like what James describes about the support efforts and education that goes on at his group. And while I see the appeal of advocating for completely eliminating
    lawsuits from the lives of physicians, is that realistic in the United
    States? Probably not. If not, is there some other way we can process the
    chance (or the experience) of having to go through a lawsuit in the
    lives of physicians? Medicine reacts to malpractice lawsuits like white
    blood cells to a virus, and as you note, it occasionally leads to very
    unhealthy, sometimes dangerous responses from those accused (I’d argue
    there were far more issues going on in the lives and/or psyches of those
    who took such dramatic action than just the lawsuit). Furthermore, the
    dread factor it causes in care providers more generally also isn’t
    healthy for practice.

    Yes, they are nasty processes to have to go
    through, but the studies show it is almost inevitable for just about
    every physician. If it can’t be eliminated, or avoided, perhaps we need
    to rethink what malpractice means for physicians? I want to spitball an idea about reframing malpractice in the lives of physicians: Perhaps instead of seeing it as a cancer to be attacked (or to fight a war over) it is better
    thought of as a known, likely side effect of being in an otherwise mostly wonderful profession, or
    like strenuous rehab that might have to be undertaken following a knee
    replacement surgery. Is it a price worth paying as part of all of the rest of the joys and benefits being a physician offers?

  • http://twitter.com/DarrellWhite Darrell White

    Defensive medicine: no amount of testing or care is enough if just a little more might be just enough to avoid a malpractice case.

    The Rand Company offered a study some years ago which found that between 5 and 20% of ALL medical expenses were a direct result of defensive medicine. Big range, but even 5% is 5% of $2.5TT or $125 Billion. Our system of punitive tort coupled with insulation of consumers of care from the cost of the care removes ALL incentive to reduce the care consumed. A patient has little economic incentive to question extra care (if they are insured), and knowing this a physician has NO economic incentive to say “enough”.

    As an expert witness in med-mal cases I’ve seen doctors settle cases that they would have won handily simply to avoid the time, effort, and emotional trauma of a trial. I heartily second the “no-fault” Swedish option. But a more important reason to second that option is to provide some support to patients harmed in medical misadventure even when it did NOT involve malpractice, as well as to prevent the tragedy of a plaintiff loss in court where true malpractice actually occurred.

    Nice post, Kevin.

  • http://www.facebook.com/profile.php?id=1231693676 Bruce Kimzey

    That means that for every 2 malpractice cases without error there are 3 cases where there was medical error. So, according to the NEJM, in a justice system like ours, where only 1 out of 5 cases (20%) actually obtain compensation,  3 out of 5 (60%) were actually entitled to compensation for medical error. That means that in 2 out of 3 cases where NEJM found that there actually was medical error, the injured party still obtained NO compensation. 

    I have been on both sides of the aisle. I spent my first 6 years as an attorney with a firm which specialized in defending doctors in med-mal cases. I’ve seen good doctors wrongfully sued but I’ve seen others sued 3 times in 3 years.

     As a teenager in 1971, my family sued for wrongful death a neurosurgeon who performed surgery on my father, a 2-time heart attack survivor, without leaving an med orders other than for elixir turpin hydrate (cough syrup). For 3 hours my Dad was dying in the ICU, the neurossurgeon couldn’t be reached, he had no one covering for him and until he coded, all the nurses had for my Dad was cough syrup.  We never got a dime.

    What we experienced wasn’t “like” a death – it was a death, a real death.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    Kevin has the right attitude. We need a non adversarial system that compensates the injured quickly, that finds the core source of the error and makes recommendations to prevent it from happening again. This may entail addressing institutional system errors, ordering additional study and training for practitioners, requiring supervision of practitioners or even suspending or revoking a license to practice. The current system is extraordinarily expensive, takes years to finally be completed and benefits the attorneys and the med mal industrial complex participants only.

  • http://www.cadencemed.com/blog Matt Langan

    It’s interesting that the “…mean indemnity payment was $274,887, and the median was $111,749″ according to the study. I thought your readers might “enjoy” these figures.

  • Joe Kosterich

    Bad outcome and bad practice are not the same but are seen as such. An adversarial system is like a lottery. Some strike it rich and others miss out. Australia is looking at a no fault disability system for people with major disability regardless of cause. Government systems are never perfect but at least this recognizes that need is not determined by how the disability has come about

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