She was one of the most highly sought radiologists in her hospital, a doctor with the uncanny ability to divine the source of maladies from the shadows of black and white X-ray films.
But one afternoon my colleague revealed that she had been named in a lawsuit, accused of overlooking an irregularity on a scan several years earlier. The patient suing believed she had missed the first sign of a now rampant cancer.
While other radiologists tried to assure her that the "irregularity" was well within what might be considered normal, my colleague became consumed by the what-if's. What if she had lingered longer on the fateful film? What if she had doubled-checked her reading before signing off on the report?
She began staying late at the hospital to review, and re-review, her work. And she worried about her professional reputation, asking herself if colleagues were avoiding her and wondering if she would have trouble renewing her license or hospital privileges. At home she felt distracted, and her husband complained that she had become easy to anger.
After almost a year of worry, my colleague went to court and was cleared of the charges. But it was, at best, a Pyrrhic victory. "I lost year of my life," she told me. "That lawsuit completely consumed me."
She was not the first colleague to recount such an experience. And far from overstating the issue, doctors may in fact be underestimating the extent to which malpractice not only consumes their time but also undermines their ability to care for patients, according to a new study in Health Affairs.
For more than 150 years, the medical malpractice system has loomed over health care, and doctors, the vast majority of whom will face a lawsuit sometime in their professional lives, remain ever vocal in their criticism of the system. But with few malpractice claims resulting in payments and liability premiums holding steady or even declining, doctors have started to shift their focus from the financial aspects of malpractice to the untold hours spent focused on lawsuits instead of patient care.
Now researchers are putting numbers to those doctors' assertions. For the current study, they combed through the malpractice claims records of more than 40,000 doctors covered by a national liability insurer. They took note of the length of each claim, as well as any payments made, the severity of the injury and the specialty practiced by the physician being sued.
Most claims required almost two years from initiation of the lawsuit, and almost four years from the time of the event in question, to reach a resolution. Cases that resulted in payment or that involved more severe patient injuries almost always took longer.
The researchers then looked at the proportion of a doctor's career spent on an open claim. They discovered that on average, doctors spent more than four years of their career -- more time than they spent in medical school -- working through one or more lawsuits. Certain specialists were more vulnerable than others. Neurosurgeons, for example, averaged well over 10 years, or over a quarter of their professional life, embroiled in lawsuits.
"These findings help to show why doctors care so intensely about malpractice and what they might face over the course of a lifetime," said Seth A. Seabury, lead author and a senior economist at the RAND corporation in Santa Monica, Calif.
The results also underscore what plaintiffs must endure. Previous studies have shown that when medical errors occur, patients prefer to have physicians acknowledge the mistake quickly and apologize as soon as possible. Though less than 5 percent of all errors ever lead to a malpractice claim, lengthy claims drag out the process and, in certain cases, hold up what may be appropriate compensation.
Patients not directly involved can be affected as well. A legitimate malpractice lawsuit sometimes results in doctors or even entire institutions changing how they practice in order to prevent similar events from happening again. Lengthy legal wrangling can slow down these potentially important improvements.
While these findings are only an indirect measure of the extent to which malpractice claims can affect doctors' and patients' lives, the study makes clear the importance of considering time, as well as cost, when looking at malpractice reform.
"If we could get these cases resolved faster, we might be able to improve the efficiency of the system, lower costs and even improve quality of care for patients," Dr. Seabury said.
"Having these things drag on is a problem for doctors and patients."
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Friday, January 25, 2013
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