February 27, 2006
Baker's Medical Malpractice Myth
I've just finished reading a book that I cannot recommend highly enough -- Tom Baker's The Medical Malpractice Myth (2005). It is beautifully written and the best summary of the literature on medical malpractice that I have ever read. Tom's summaries of the academic literature on such topics as the incidence of adverse medical outcomes, on the pattern of medical malpractice insurance rates, whether doctors practice defensive medicine, and what reforms make sense are simply marvelous. As Tom says repeatedly, "[t]he real medical malpractice problem is medical malpractice. It is not pretty to say, but doctors and nurses make preventable mistakes that kill more people in the United States every year than workplace and automobile accidents combined. ... The problem is not that there are too many claims; the problem is that there are too few." (157)
The really deep puzzle about all this is why, given the overwhelming evidence that there is no medical malpractice litigation crisis, legislators, the President, the AMA, and others believe that there is. Honestly, I can't figure it out. Is this just bare-knuckles interest-group politics? Is it willful ignorance?
Be sure not to miss this spectacular piece of work. The story of how the American Society of Anesthesiologists reformed themselves so as to reduce the incidents of preventable adverse outcomes and saw, as a result, a decrease in their malpractice insurance premiums is as instructive as anything I've ever read in this area.
TSU (Thomas S. Ulen)
February 27, 2006 | Permalink
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The American Society of Anesthesiologists decreased their error rate 95% and saw a 40% decrease in premiums. That remaining 12:1 ratio tells you precisely why doctors think there's a medical malpractice crisis; they view the majority of malpractice cases as divorced from actual malpractice. It's hard to read JAMA articles like Merenstein's and come away thinking the status quo is worth preserving. I was disappointed that the book simply disregarded many studies showing problems, including Kaplan/Posner's work on the ASA study.
Posted by: Ted | Feb 28, 2006 4:01:15 AM
Sorry, that's Caplan with a C. (Caplan RA, Posner KL: The expert witness: Insights from the Closed Claims Project. ASA Newsletter 61(6):9-10, 1997; Caplan RA, Posner K, Cheney FW: Effect of outcome on physician judgments of appropriateness of care. JAMA 265:1957-1960, 1991).
Posted by: Ted | Feb 28, 2006 4:07:01 AM