How transparency reduces malpractice and defensive medicine

Physician errors have been the subject of discussions about both health care costs and health care quality.

We are told that if we reform the malpractice system — capping damages — that physicians will practice medicine less defensively and costs will go down as a result. We are also told that the quality of care delivered by our health care providers is less than optimal — there are estimates that nearly 100,000 people die from medical errors each year.

At first it seems that the solution to one problem will compound the other. For instance, if we do indeed place a cap on malpractice damages, this might insulate physicians from the risks of making a medical error. Now, I’m not saying that this would cause physicians to go out and make more mistakes intentionally, but it might make them more open to cutting corners as the disincentives would be newly limited. Consequently, we might see a sizable increase in deaths from medical errors.

But I’m not sure that these two problems are at odds. I think, instead, that the solution is more transparency about failures, leading to a better understanding of the cause of such failures, and concrete action plans for avoiding them in the future. With this approach, the number of deaths from medical errors would be reduced because we would know better what not to do.

Simultaneously, the practice of defensive medicine would be reduced because physicians would have a clear set of best practices to follow — and malpractice reform could focus not on capping damages, but on ensuring that physicians adhered to the best practices established by empirical research. After all, this is medicine we’re talking about. It may in part be an art, but it is also a science. And, if anything, it seems to be the science that we value most, so perhaps we should start acting like it across the board.

My inspiration for posting on this topic came from reading a great piece Maggie Mahar wrote about the lack of regulations for hospitals to report accidents — including incidents where patients were accidentally burned during fires in the operating room. Of course, the reporting requirements vary from state to state. But wouldn’t a federal requirement be the way to go here? Or, as Mahar suggests, shouldn’t hospitals want to improve? If so, why don’t they just go ahead and become transparent on their own?

My strong hunch is that advertising your failures isn’t a good business model in the short term — though it could make you the best in the long term. And, what applies to hospitals should, in my opinion, apply equally to physicians. The only way to get stronger is to know — and improve — your weaknesses, not hide from them.

Brad Wright is a health policy doctoral student who blogs at Wright on Health.

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