Can we work together to improve patient safety?

By Charles A. Pilcher MD FACEP
March, 2015

DISCLAIMER: In the January “Perspective” I presented Medical Malpractice Insights, a new publication for physicians which helps them learn from medical malpractice lawsuits. Because this is so important, I am continuing my “rant” in this post and seeking your involvement. I expect differences of opinion and am interested in your thoughts.

I am tired of physicians – other than defendants – learning nothing from medical malpractice lawsuits. We need to change that.

For the past 7 years I have provided attorney readers of the Medical Malpractice Bulletin with information from the medical literature to help you understand the strengths and weaknesses of a case. About 2 years ago I realized — to my embarrassment – that my physician colleagues were learning none of what I have learned working as an expert witness. So last fall I embarked on a project to share the key “Takeaways” from selected verdicts and settlements. The new publication is somewhat similar to this one – but for physicians. My hope is that the information I provide will improve patient safety and remind docs how to avoid the mistakes that led to a lawsuit against a colleague.

The new FREE publication is called Medical Malpractice Insights – Learning from Lawsuits (MMI). You can view a sample issue here.

The project is borne of the following 6 ingredients:

  • My passion for improving patient safety. (I have been involved in healthcare quality/safety and risk management my entire career and currently chair our hospital board’s Quality & Safety Committee.)
  • My irritation at seeing similar mistakes being made by presumably competent physicians who know nothing of what just happened to a colleague.
  • My dismay that helpful information for physicians from the highest level of medical error – med mal lawsuits – is being buried by insurers and attorneys.
  • My desire to provide education in a quick, easily readable, non-pedantic, mobile format suitable for the limited time available to busy physicians.
  • My admiration of what I perceive to be immense transparency by our Canadian colleagues regarding the results of malpractice cases. (A single insurer with a captive audience certainly helps.)
  • My hope that MMI will help bring our country’s quality metrics up to at least the level of Canada. (And, yes, Canada has better quality metrics and far lower insurance rates than the USA, as do most other developed countries. Check out the  Commonwealth Fund International Health Studies for 2013 and 2014.

I trust that we all are equally upset when we see potentially avoidable mistakes because physicians are simply uniformed of common, avoidable pitfalls. For example, I have just learned of a fourth case of a missed spinal epidural abscess (SEA) – all in the past 4 years and all in just Washington State. One person died. Two are quadriplegics. The 4th case is still in early discovery. 

The first case was one too many. The results of that lawsuit should have been made available to every doc in the country. Had they been reminded of the standard hallmarks of the diagnosis and applied some critical thinking to include SEA in a differential diagnosis, the outcome could be:

  • 3 fewer Washingtonians would have suffered
  • the providers in the other 3 cases would have avoided the immense stress of a lawsuit and
  • the insurance pool would be millions of dollars richer.

The MMI publication is formatted to be short enough to read in about 3 minutes and is light enough to keep readers engaged in an otherwise difficult subject. Since publication began, readership is growing rapidly. Feedback from nearly 100 of the hundreds of physician readers is an unbelievable 96% positive. There have been zero opt-outs. A few want more information, but an in-depth analysis is not the publication’s intent.

So, now I would like your feedback.

  • How can we work together to improve physician education using the outcome of med mal lawsuits?
  • Can we somehow change the system that allows confidential settlements?
  • How would greater transparency affect settlements?
  • Do insurers – and the medical profession – have any idea of the negative consequences of their current position on confidentiality?
  • What is the cost of confidential settlements in terms of patient lives and litigation of more mistakes?
  • Would more cases go to trial?
  • What can attorneys do to help? Lawyers expect doctors to clean our own house, but what are lawyers really doing to show us how? Lawsuits resulting in huge settlements have done little to improve patient safety.
  • Shouldn’t attorneys and med mal insurers (who are at the point of the spear in terms of patient safety) be working with physicians to learn from these experiences and make medicine safer?
  • Is there a role for the legislature?

Finally, if you see value in this concept, please show your support by sending me a case summary or two that I can anonymize, format, apply the “Takeaways” and share with MMI’s physician readership.

I really respect the many attorneys I’ve worked with over the years, but I’m tired of the status quo. Whether you agree or disagree, join the conversation.

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