The Nine Forces Converging On Primary Care: #7 Malpractice And The Specter Of Defensive Medicine

The seventh in a series of metaphoric bad weather descending on primary care medicine involves the ever-present threat of malpractice. In The Familiar Physician: Saving Your Doctor in the Era of Obamacare, I referenced a study conducted by the Physicians Foundation entitled A Survey of America’s Physicians: Practice Patterns and Perspectives. This extensive project identified “liability and defensive medicine” as the least satisfying part of medical practice. As the survey drilled down a bit words like “resentful” and “angry” often come into play – not only at the threat of being sued, but also the corresponding need to practice expensive defensive medicine, not in order to validate a diagnosis, but to reduce the risk of a lawsuit.

While there is considerable variation involving malpractice on a state-by-state basis, the national picture reveals that the total number of lawsuits is on a downward trajectory. This direction is balanced, however, by the fact that the actual amounts per damage award are growing. At the same time, insurance premiums are rising again after a recent plateau while the number of firms offering coverage decreases.

The problem is also widely distributed. A 2010 American Medical Association Physician Practice Information survey reveals that nearly 40% of primary care physicians have been sued in their careers, as have 34% of general internists. As you might expect, the numbers get even higher for surgeons.

In addition to the costs of malpractice insurance, the long hours involved in dealing with lawsuits can represent a considerable drain on time. In many cases, claims, even those not leading to lawsuits, can take years to resolve.

According to the Physician Insurers Association of America (PIAA), a group of doctor-owned or operated liability carriers, the highest percentage of malpractice suits, more than one third, are related to errors in diagnosis.

These claims are often complicated by insufficient documentation and poor communication between physician and patient, both of which may be attributable to the inefficient business model and structure currently in place in many medical offices in America.

Within this context, the one thing that does look fairly certain based on both research and a very large amount of anecdotal evidence is that a causal relationship exists between medical malpractice filings and the erosion of the interpersonal relationship between doctor and patient. The slow but steady disappearance of The Familiar Physician is creating a lack of trust, a weakening of the traditional bond between provider and consumer that even needed tort reform and improved risk management won’t improve.