ospitals and insurance companies can readily obtain information about a physician's malpractice claims, but in most states the public cannot. But in at least 15 states, the Federation of State Medical Boards says, some such records are available on official Web sites. Physician groups in most states oppose the practice. Gale Scott discussed the issue with the presidents of two medical societies. These are edited excerpts of those interviews.

YES
Dr. Francis X. Rockett, President, Massachusetts Medical Society

The Massachusetts Board of Registration in Medicine began its Physician Profiles Project in 1996. The project has resulted in a Web site where visitors can get information about paid malpractice claims along with a physician's business and professional demographics, education and training, hospital affiliations and the insurance plans accepted. If the doctor has had disciplinary actions or a criminal history that will also be online.

Many doctors opposed doing that, but it was obvious that if we didn't work with our state medical board they planned to post that information without any of our input.

So we helped set it up. The site starts out with some basic information about a medical practice. You can say whether you are accepting new patients, what insurance plans you take and what hospital affiliations you have, where you did your training and whether you are board certified in your specialty. There's a section for honors and publications. So everyone likes that.

Then there comes a section for malpractice, but it gives some context. For instance, my entry shows that I am a fully licensed neurosurgeon in practice for 43 years and that I am one of 163 physicians licensed in this specialty in Massachusetts. Then it says that my specialty is one with a high rate of malpractice cases, that 66 of those 163 doctors in the state have made a malpractice payment. It will also show you that I've had only one in the last 10 years.

The site doesn't give you any details on the case other than the date it was settled.

Some people advocated including the dollar amounts of the awards, judgments and settlements, but we felt that wouldn't be fair to physicians. The number of malpractice payments made is not a good way to indicate competence or incompetence.

We convinced all concerned that the medical details served no purpose. You can have a marvelous surgeon who takes on hard cases.

You might have a doctor who deals with newborn infants with impossible chances. But even if that doctor does everything possible there can be a bad outcome, and that will bring on the suit.

We also rejected including all claims brought against a doctor since that would include cases with no merit. The site doesn't list the amount paid either. We didn't feel that was useful. But it does list the amount of the award as average, below or above in context with the specialty.

It has been a very popular site. The board's 2000 annual report shows the site has had over 7.4 millions visitors since it opened in 1996.

It turns out most patients are using it just to see whether their health plan is accepted and to look at educational credentials.

Physicians are eager to see bad doctors sorted out and the situation fixed or the doctor removed from practice. The real task is to give the state boards the resources to do investigative work. But having some malpractice information available to the public does no harm.

NO
Dr. Ronald L. Ruecker, President Illinois State Medical Society

Our medical society believes that malpractice information is not necessarily an indicator of a physician's quality. A doctor can do everything right and still have a patient die, and a lawsuit may still be the result.

Malpractice situations often fluctuate with the physician's specialty and with the mix of cases. Some of the world's foremost doctors have been involved in malpractice cases and are still considered authorities in their fields. The absence of malpractice suits does not guarantee the doctor's quality either.

If data on malpractice are on the World Wide Web for everyone to see, our concern is that the information will be inaccurate or not subject to review by the physician in question, or both.

Malpractice information is already available to hospitals and health plans through the National Practitioner Data Bank, a database created by the federal government. It is designed to try to track physician discipline.

Since hospitals can get access to it, it's probable that any doctor can get access to his or her own information in order to change it if it isn't accurate. And hospitals and insurance companies know how to interpret malpractice data.

But if malpractice data are released to the public, it raises too many questions. Peer groups within medicine have varying degrees of what's normal.

For instance, in obstetrics and gynecology, having three lawsuits in 10 years might not be unusual. In another specialty it might be alarming. How can we advise the public when a rate is high when there are so many variables?

Malpractice clearly varies significantly with geography as well.

In our state, Illinois, physicians know that if they practice in Chicago or any other big city, there is a significantly higher number of malpractice filings.

That's because urban juries tend to favor plaintiffs and there are some very aggressive trial lawyers.

Also, how would you handle data on suits that were settled, often not because the physician did anything wrong but because the insurance company felt it was cheaper than fighting?

Fortunately that trend seems to be going away since it encourages frivolous suits, but there are still many that have been handled that way. That could reflect unfairly on the doctor.

There are, of course, times when an accident happens or an error has been made that breaches the standard of medical care. That's what lawsuits are there for.

But mostly errors are just part of human nature. No physician gets up and says, "I'm going to make errors today," so I don't think the threat of malpractice is a deterrent. Knowing that a suit would be publicized wouldn't reduce the error rate.

What would happen is that the sensational details of a medical accident could be publicized and certain physicians with long histories of competence would have their reputations damaged unnecessarily.

Malpractice suits don't always mean doctors are not competent. I referred my wife to a surgeon who had had several suits, and he is extremely competent.

Patients are very well protected already by the scrutiny doctors' records get by hospitals and insurance companies. It's not the old boys' club anymore. We are policing our profession. Publicizing malpractice data won't make things safer.