Last week the Wall Street Journal reported that Minnesota is one of the worst states when it comes to punishing doctors for malpractice. Using data from the Public Citizen Health Research Group, Minnesota ranks second to last, number 50 out of 51 state medical boards surveyed. (Washington, D.C., was included as a state in the study). There were 1.24 serious actions per 1,000 physicians in Minnesota between 2005 to 2007.
The rankings can mean two things, Jacob Goldstein reported in the paper’s health blog. Medical boards that are well funded and staffed tend to be more effective and tend to have more disciplinary actions, argues Sid Wolfe with the Public Citizen Health Research Group.
But the Federation of State Medical Boards sees it differently, arguing that the most effective medical boards are successful in preventing serious problems and therefore have low numbers of disciplinary actions. "…[T]he citizens of those states would be better protected," they argue in an American Medical News story about the data.
Nationwide, disciplinary actions against doctors have been falling for several years. Serious ramifications such as license revocation were down 17 percent between 2004 and 2007, according to an American Medical News Report citing data released by the FSMB.
But it’s hard for a patient to report a problem if there isn’t a clear error, says Thomas Gallagher, an M.D. and associate professor of medicine at the University of Washington Medical Center in Seattle. Only about one in three medical errors are disclosed to patients or their families. Clear-cut errors such as wrong-side surgeries, like the recent incident at Methodist Hospital in St. Louis Park, are easier to identify. Other errors such as delayed diagnosis are harder for physicians or patients to prove.
As reported in our feature story, litigation has changed the medical world in many ways. Some doctors refuse certain procedures for fear of lawsuits, and the number of medical students wanting to go into the more complex specialties has declined because doctors fear the ramification of medical mistakes and rising insurance costs.
But it’s important to remember that everything looks different in hindsight. Take breast cancer, for example. Once a woman is diagnosed, she’ll often go back and look at previous mammograms and see abnormalities, "something they think should have been caught earlier,” says Gallagher. “But, for the physician, many times it was appropriate to wait and watch."
While patients have had access to doctors’ malpractice records for years, only recently has there been a movement within the medical community to allow doctors to access records on patients to determine who might be litigious. There have also been documented cases of doctors refusing to provide care for patients they think might be likely to sue. “At the core of all this is the problem that health care in this country is difficult to obtain and expensive and based on an insurance system," says Laurie Zoloth, director of the Center for Bioethics, Science, and Society at Northwestern University in Chicago.
If a patient is seriously harmed it could require months, years, even a lifetime of care and follow up. It’s expensive, and often it’s not covered by insurance.
It’s only natural for doctors to be worried about taking on a possibly litigious patient, says Albert Wu, an M.D. and professor in the Health Policy and Leadership department for the Johns Hopkins Bloomberg School of Public Health.
"The litigation climate has created a heightened and perhaps unrealistically high level of fear of litigation within the medical community, and this can sometimes distort a physician’s practice so that they may do something out of concern for avoiding a lawsuit," says Wu, who is currently in Geneva as a senior advisor to the World Health Organization’s patient safety program.
Over the years there has been progress in the area of disclosure, and doctors are learning to be more open with patients, says Gallagher, the M.D. and associate professor in Seattle. The Star Tribune touched on the story in March.
“It’s both the right thing to do and there’s a clear expectation in medicine that when there are errors in patients the family should know about that. …Some believe this makes families less likely to sue, but the evidence is not definitive on that yet.”