Medical Negligence: A Return to Trust
Original article was published by WHO, World Health Forum 1997 Vol. 18 No. 2, pages 195-196. Readers are encouraged to read the work of the American College of Obstetricians and Gynecologists (ACOG) and send their comments and suggestions.
I wish to congratulate World Health Forum for publishing a well-rounded Round Table discussion on the subject of medical negligence (1). As an obstetrician and gynecologist in the USA I am faced with this challenge in everyday life, and I would like to share with readers my misgivings about the assessment of medical acts.
Practicing medicine in the USA - especially obstetrics and gynecology - is like walking through a minefield. Life is not and cannot be free of risk. There is no activity, process or product that is free of risk: indeed, living itself poses risks. Society in the USA has adopted the "Zero Risk" concept, which has destroyed the art of medicine. Patients are treated as if they have no responsibility for their illnesses and injuries. There is no doubt that untoward occurrence should be minimized, but there are bound to be errors, injuries and deaths. Most of the time, untoward outcomes are not because of a physician's negligence and malpractice but are beyond human control. Take the example of cerebral palsy, which has so many variable factors. Science and research have not advanced far enough to give us all the answers about the development of brain and intelligence.
"Dramas" are played again and again in the courtrooms, before a judge and jury who have no knowledge of medical sciences, thus making the courtroom overly emotional and theatrical rather than scientifically truthful. About 85% of obstetricians and gynecologists in the USA are sued at least once in their careers for negligence and malpractice, and about 65% - 70% are sued 2-3 times. It is difficult to imagine that the rigorous US medical education system is producing 85% "incompetent physicians"!
A physician of one specialty may not be competent to judge the standard of care of another specialty, because of research and technical advances in the various branches of medicine in the last 20 years. How, then, can judges, lawyers and juries with no background in medicine be qualified to make a valid judgment? A much deeper question is, Would even doctors of the same specialty be an impartial jury? I am not sure they would. Who are the "expert witnesses" in our courts? If the plaintiff's lawyers are driven by contingency fees (in other words, by greed rather than justice), the expert witnesses may be expected to react similarly, even though they are not remunerated.
Science and law must coexist. It would be for the good of all if this relationship were a mutually helpful one; at the very least neither one should exploit the other. Most physicians want to be able to respect the law, and have faith in a just order. Extracting money from medical malpractice insurance companies solves little. Many cases are brought to court not to win but to force a defendant to settle for a sum of money. The defect is apparent: the emphasis is on money.
Win or lose, a malpractice suit smears the physicians. Some medical professionals may be discouraged and give up the practice of medicine altogether and others may be deterred from pursuing careers in medicine.
The relationship between doctors and patients has changed, which can affect the tender loving care patients expect to receive and their attitudes towards their doctors. Sooner or later we must return to trusting our physicians to furnish quality, caring and cost-effective health care. If we are truly interested in ensuring that no one suffers injustice, then both medical and legal professionals must recognize their limitations. In my opinion, we should end the common law concept of monetary liability for medical negligence.
Dr. Rita Luthra
Director, Women's Health & Education Center
Riis P. Medical Negligence: World Health Forum, 1996, 17: 215-218; discussion 219-239.
The liability crisis facing obstetricians and gynecologists across the country has reached a dangerous level. If it is not resolved soon, it might threaten the availability of quality care to all Americans. The entire healthcare system might be adversely affected. The American College of Obstetricians and Gynecologists (ACOG) has created RED ALERT brochure to give to the patients, to educate them about professional liability crisis and how they can help. ACOG task force with American Academy of Pediatrics has published the report on: Neonatal Encephalopathy and Cerebral Palsy. It is the best example of an adverse outcome that has no correlation with medical negligence or error. The report is endorsed by government and non-profit groups, including the CDC, the National Institute of Child Health and Human Development and the March of Dimes. Please visit ACOG's web site for up to date information.
Dedicated to Women's and Children's Well-being and Health Care Worldwide