“Evidence-Based” Medical Malpractice Research and Changing the Patient Safety ParadigmTimothy C. Allen, MD, JD
Published: 16 August 2012
Cite as: Allen TC. “Evidence-Based” Medical Malpractice Research and Changing the Patient Safety Paradigm. Bull Health L Policy. 2012;1(1): e2.
“We are told that our medical malpractice system is broken. Doctors are sloppy without punition; patients are injured without compensation; juries seek revenge without proof; and lawyers get rich without justification.”1
The problem of medical errors is staggering2 and efforts to address the medical liability crisis have provided at best “only symptomatic relief.”3 Medical malpractice lawsuits and the plaintiffs’ lawyers that bring them are unpopular; but nonetheless the debate over changing health care liability remains centered on “tort reform”—capping of non-economic damages within the long-standing paradigm of negligence-based medical malpractice litigation. Serious alternatives to negligence-based medical malpractice liability have been proposed but not realistically considered.2 Perhaps the best alternative to medical malpractice litigation, no-fault liability, remains academically but not politically popular and has only been broadly instituted successfully in Virginia and Florida for cases of severe newborn injury.2
The fundamental problem—medical error—requires a systems approach similar to approaches widely and routinely used in industry, with a focus on determining error epidemiology to correctly identify medical error (as opposed to bad outcomes unassociated with error) and utilize all available tools, including, but not limited to, risk management, error disclosure, continuing education, and apology in order to reduce medical error. The “shame and blame” approach of medical malpractice litigation not only fails to achieve medical error reduction; indeed, its adversarial structure is counterproductive in those goals.3
The fundamental problem—medical error—requires a systems approach similar to approaches widely and routinely used in industry, with a focus on determining error epidemiology to correctly identify medical error (as opposed to bad outcomes unassociated with error) and utilize all available tools, including, but not limited to, risk management, error disclosure, continuing education, and apology in order to reduce medical error. The “shame and blame” approach of medical malpractice litigation not only fails to achieve medical error reduction; indeed, its adversarial structure is counterproductive in those goals.3
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