The threat of being sued for medical malpractice looms over most physicians – but thus far, tort reform’s been failing on the federal level. A new free online JAMA article outlines the current medical liability climate, and ways that it can be amended. The piece, titled “The Medical Liability Climate and Prospects for Reform,” contained a pretty interesting chart that spelled out the different approaches:
The article reviews the pros and cons of the communication-and-resolution approach. With this technique, providers and insurers “discuss unanticipated care outcomes with patients and families, conduct an expedited investigation, provide the patient and family with an explanation of why the harm occurred, and offer an apology and acceptance of responsibility appropriate to the circumstances.”
The JAMA article says this approach has worked for academic medical centers, which “have reported substantially lower malpractice claims and costs. The reductions seen have exceeded the effects of any public-law reform, including damages caps.” The authors of the article – Michelle M. Mello, JD, PhD, David M. Studdert, LLB, ScD, and Allen Kachalia, MD, JD3 – list three reasons this approach is a good one:
First, the traditional deny-and-defend approach is often costly and particularly wasteful in meritorious cases in which it is likely the plaintiff will eventually receive some compensation.44 The approach also breeds ill will among the parties, which can prolong litigation and increase settlement demands. Second, communication-and-resolution programs reinforce the shift in health care toward greater transparency about adverse outcomes. Third, research has identified poor communication, lack of candor, and a need for information as major reasons patients sue.
The authors go on to say that this technique has several limitations. It works best at hospitals that self-insure and employ most of their physicians and in states with tort reform already in place, particularly damage caps. The approach is also time-intensive and – like most management strategies – only works if senior executives have fully bought into the idea.
The article is accompanied by an editorial that asserts that the time’s right to explore these alternate pathways. It begins:
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Crisis, it is said, means both danger and opportunity. In medical liability reform, however, greater opportunity may lie in noncrisis. In this issue of JAMA, Mello and colleagues offer data suggesting that no crisis of the conventional sort currently exists in the medical malpractice system.
