In Opinions, which is section 9.7.1 of the American Medical Association (AMA) Code of Medical Ethics, a physician serving as an expert witness has a duty to act as an objective, independent professional whose opinions are based on science, and not act as an advocate whose opinions win lawsuits. The question, which I now raise, is: “Are opinions expressed by a medical expert, which have 95 percent confidence (the …

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Nationwide, 200,000 lawsuits are filed per year. Among them are between 66,000 and 85,000 medical malpractice cases; however, this number is uncertain. Between 22,000 and 44,000 of these culminate favorably for the plaintiff as a settlement or a verdict. The remainder, two-thirds of all malpractice claims, are dropped or otherwise end favorably for the defendant. These statistics suggest that many medical malpractice claims are frivolous yet are still represented, and …

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Most medical experts in medical malpractice are influenced by bias. Yet, they produce a certificate of merit. There are many types of biases, but I concentrate on only those biases that represent a systematic distortion that directly undermines the reliability of certainty in data and are measured by Type I and Type II errors.

Under this circumstance, merit can be regarded as certainty minus those biases. Those biases are selection bias, …

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We are frequently told that our health care system is expensive. However, most of us, including physicians, have no notion about what the health care system really is, to judge whether or not we are getting our money’s worth.

There are four major structural models for a health care system:

• The Beveridge model (socialized medicine): Health care is provided and financed by the government through tax payments (e.g., United Kingdom’s NHS).

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Tort reforms for medical malpractice preoccupy much of the legislative agenda for any state legislature as well as much of the time and budget of a state’s medical society. However, in truth, state legislators and the administrators of medical societies only care when it is to their advantage.

Because I am a physician in Maryland, I use Maryland as the example. In most states, tort reforms achieve six goals:

• Caps: In …

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Conventionally, medical malpractice is argued using inductive reasoning. There is nothing wrong with inductive reasoning. It is a component of critical thinking. However, it is just a component. Inductive reasoning is more subjective than objective and the influences of selection bias, avoidance bias, and confirmation bias are undetectable.

Deductive reasoning is also a component of critical thinking. It is not immune from these same biases; however, deductive reasoning is more robust …

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Most recognize me from posts about deductive reasoning on KevinMD, but I never explain deductive reasoning’s effect on a conventional medical malpractice lawsuit. Here is how it affects such a lawsuit.

All medical malpractice lawsuits have four things in common:

• All have an underlying complication, either an error-of-nature, which is caused by random chance, or a medical error, which is caused by the medical intervention.
• All test the premise that there …

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Most recognize me for extolling the virtues of deductive reasoning in medical malpractice case review, but I never explain why I am so worked up over medical malpractice. Some would point out, “There are only 17,000 malpractice lawsuits filed per year out of a total of perhaps as many as 40 million lawsuits filed nationwide. Therefore, medical malpractice represents 0.04 percent of all lawsuits filed. What’s the big deal?” …

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Frivolous medical malpractice lawsuits are endemic and infect everyone whether they realize it or not. The greed of plaintiffs, attorneys, medical experts, and malpractice carriers, coupled with the ineptitude of the tort system, causes avoidable costs. Everyone pays the price.

Some plaintiffs sue for medical malpractice just because they harbor a grievance against a doctor and their claim has no attributable merit. Plaintiff attorneys, who are looking for business, advertise …

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It is beyond a doubt that, in many states, including the state of Maryland in which I am licensed, tort reforms for medical malpractice occupy a good part of the legislative agenda. In Maryland, tort reforms bring:

• Caps: The cap on noneconomic damages is first set at $650,000, and increases by $15,000 each year. Medical malpractice has a separate cap structure; however, the cap is $905,000. There must be an …

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“No medical malpractice lawsuit is frivolous,” is the narrative echoed by plaintiff attorneys. Medical malpractice lawsuits are vastly underrepresented. Also, because frivolous lawsuits are too expensive to litigate, expense is a natural deterrent for filing one. Plaintiff attorneys have controlled this narrative for as long as I’ve been in practice since 1972.

Recently, I examined the veracity of this claim. Indeed, there are 66 million civil lawsuits filed in the …

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I define a frivolous medical malpractice lawsuit as being caused by a random error of nature.

Plaintiffs are entitled to feel aggrieved and to seek legal counsel. Some, however, have ulterior motives.

Plaintiff attorneys are “good Samaritans.” They work for a contingency fee. This invites ulterior motives; however, because these attorneys bear the cost, motives do not matter. Only the value of a case matters and there is artificial intelligence to weed …

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When I am sued by a prominent medical malpractice plaintiff attorney, I open the firm’s website. Despite the lawyer’s prominence, the website uncharacteristically solicits for medical malpractice, claiming, “If you have a phone, you have a lawyer.” We all know that it takes more than a phone; it takes a case. What I have learned since that day is a lesson for every physician practicing medicine because each, like it …

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Frivolous medical malpractice lawsuits are endemic and infect everyone whether they realize it or not. The greed of plaintiffs, attorneys, medical experts, and malpractice carriers, coupled with the ineptitude of the tort system, causes hopelessness in physicians. Everyone else pays the price.

Plaintiffs sue for malpractice even when a claim has no attributable merit. Plaintiff attorneys, who are looking for business, advertise “if we don’t win, you don’t pay.” Once …

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Eighty-five thousand medical malpractice lawsuits are filed per year, but the total number of claims reviewed by lawyers is unknown. What underlies their decision to proceed is their inability to determine which complication results from a systemic medical error in a medical intervention and which is just a random error of nature.

Reflected in this 85,000 is that two-thirds—52,000—are summarily dismissed and 4,600 are defense verdicts, and one-third—27,000—are settlements and 1,400 …

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All medical malpractice lawsuits stem from complications caused by medical interventions. Some complications are random errors of nature, which are unpreventable. Others are systemic medical errors, caused by medical interventions gone astray. Clinically, a medical error and an error of nature are indistinguishable. Herein lies the problem in medical malpractice.

It is not that the inability to differentiate a systemic medical error from a random error of nature is unknown. On …

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Risk management has been around for centuries. In ancient times, there were oracles and soothsayers. In the 1950s, risk management became a science. Nevertheless, 75 years later, a medical malpractice lawsuit is still a problem. An unknown number of claims are reviewed by lawyers, but 85,000 lawsuits are represented. Of these, 66.6 percent are frivolous.

It stands to reason that many meritorious cases are reviewed but are never represented. There are …

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