Dr. Robert Glattner posted a very interesting article on Forbes.com yesterday that discusses the need for malpractice reform. It is well worth the read. I do have a couple of criticisms of his thesis, however.
First, Dr. Glattner cites a recent RAND Corporation study for the proposition that “waiting for the resolution of [malpractice] claims can take up more than 10 percent of the average medical career.” While the study does, indeed, conclude that the average physician spends 50.7 months of an assumed 40-year career with an open, unresolved malpractice claim, it must be borne in mind that this does not mean that the physician spends 50.7 months dealing with the claim instead of practicing medicine. The time commitment of the physician to an open claim is actually relatively minimal. Other than preparing for and giving a deposition, which may take several days, and possibly preparing for and participating in trial, which may take several weeks, most physicians actually spend very little of their day to day practice dealing with these claims, regardless of how long they take to adjudicate.
My primary disagreement with Dr. Glattner, however, is with his statement that “the wide-ranging effects of lengthy malpractice claims until resolution likely contributes to the costly practice of defensive medicine.” I believe this overstates the conclusion of the study he cites. While there are certainly negative effects associated with lengthy adjudication, these primarily relate to the stress on the physician associated with having an open claim not to the amount of time the physician actually spends away from his or her practice. There is little evidence to support a connection between the length of adjudication and the practice of defensive medicine. It is not at all clear that reducing the amount of time it takes to adjudicate a claim would reduce defensive medicine, and I do not believe the RAND study supports this conclusion. Reducing the number of claims and the size of payouts would go much farther toward reducing defensive medicine.
The subject of tort reform is a complex one that we will frequently discuss on this blog in the future. There is little doubt that both patients and physicians would benefit from a more streamlined process. Where I part company with Dr. Glatter is in his assertion that a reduction in defensive medicine would be among those benefits. Simply shortening the time associated with open claims would likely have little effect on defensive medicine.
In the end, the best way to reduce the number and size of malpractice claims (and thus influence the practice of defensive medicine) is to reduce the incidence of malpractice. The advent of evidence based medicine is a significant step in the right direction, as are the introduction of checklists advocated by Dr. Atul Gawande and the application of airline industry-type systems analysis to the medical profession. All of these provide exciting opportunities to reform and improve the delivery of health care and reduce the incidence of malpractice.