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http://www.nytimes.com/2003/01/06/opinion/06KRIE.html

Doctors Belong in Hospitals, Not Courtrooms

By LLOYD M. KRIEGER

EVERLY HILLS, Calif.
The new year started with a medical crisis that could spread. Surgeons at four West Virginia hospitals began their walkout on New Year's Day, in protest of malpractice insurance costs. Many operations were canceled, and some patients had to be moved out of state for treatment. In Pennsylvania, a similar walkout was only narrowly averted after an 11th-hour intervention by the governor.

The problem with medical malpractice is severe. A recent report by the Institute of Medicine estimates that at least 44,000 and as many as 98,000 hospitalized Americans die every year as a result of medical errors. Those figures exceed the number of people who die each year of breast cancer or in car accidents. Clearly, the victims of medical errors and their families deserve compensation. But resolving these cases under current tort law only hampers medical care.

We doctors are now obsessed with the legal system. When I'm in the surgeons' lounge at my hospital, I don't feel like a doctor, given all of the legal jargon flying back and forth among my colleagues. Instead, it feels as if I'm in some sort of lawyers' confab. Rather than discussing medicine, we talk about which colleagues have retired early because their malpractice premiums hit six figures. It's the same at professional meetings. Instead of attending lectures on the latest advances in our specialties we sign up for the ever more frequent workshops on the finer aspects of tort law.

I went to medical school to become a doctor, not to become a moderately knowledgeable legal hack. I don't want to practice defensive medicine, ordering unnecessary tests out of fear of litigation. I don't want to evaluate new patients for signs of litigiousness instead of disease. I don't want to squeeze extra patients into my schedule just so I can pay down my malpractice premiums.

But the system is now compelling me to do all these things — and I know many of my colleagues feel the same way. In some states doctors in the more high-risk specialities like neurosurgery and obstetrics pay as much as $200,000 a year for malpractice insurance. I have not been sued for malpractice (yet). But my insurance premiums increase each year anyway, forcing me to raise my rates, too. If I'm a good doctor, why do I — and you — have to pay for the errors of others?

Making it more difficult to file malpractice suits and imposing caps on excessive awards for pain and suffering, as the surgeons in West Virginia are demanding, is a start. But this won't get to the deeper problem: Mistakes do happen, and they have consequences, sometimes dire ones. Rather than focusing on rewarding victims and their lawyers, we should concentrate on creating fewer victims — that means changing how we train doctors, track and correct errors and mete out punishment.

Under the current system, catastrophe is the impetus to examining the conditions that can lead to error. Doctors, hospitals and medical boards should be more proactive. We should be more vigilant in enforcing laws that cap the number of hours worked by residents. There should be a uniform system for reporting and analyzing medical errors nationwide. Patient records should be better coordinated — while taking care to protect privacy — so that doctors can easily gain access to a patient's complete history. My mechanic has better records on my car than I have on some of my patients. Peer review of the day-to-day care of patients should be the first line of defense against poor care — more involved medical boards should monitor activities continuously and not wait for serial offenders before taking action.

Of course doctors, being human, will continue to make mistakes. But everyone would benefit in a system that encouraged doctors to be the best doctors they can be, rather than lawyers in training.
 

Lloyd M. Krieger is a plastic surgeon.

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