Threat of malpractice suits primary cause of moral distress

Dr. Pauline Chen’s concern over the difficulties, the “moral distress” that doctors and nurses feel because of pressures put upon them by administrators, insurers , lawyers, patients’ families and even one another is timely (www.nytimes.com, Well Blog, Feb 5).

This problem is not new though. It has existed for over two decades or more. Particular emphasis however needs to be placed on the way opportunistic malpractice lawyers launched frivolous malpractice suits on innocent doctors. As malpractice suits increased in number and in size of awards starting in the mid-nineties, doctors found their malpractice insurance premiums going out of sight.

But besides the skyrocketing costs of their malpractice insurance, doctors were threatened by other consequences. Their reputations and livelihoods were often at stake, not to mention the emotional stress they were forced to undergo while a suit worked its way through the litigation pipeline, a process that sometimes took from five to seven years.

Thus, in efforts to ward off any malpractice suits and to have good defense in case one were filed, many doctors started to practice defensive medicine. That is, they frequently ordered more tests and consultations than necessary. This raised the cost of health care immensely. It attacked doctors’ integrity because of the unnecessary tests they ordered and the sometime heroic efforts and resources they spent on saving patients for whom there was little hope of ever saving.

This pressure to “do everything” in order to avoid suspicion of neglect or under treatment and allegations of medical malpractice created a schism between doctors and patients. Increasingly, doctors started to view patients as potential lawsuits and the media’s reporting of dramatic malpractice suits lessened patients’ confidence in doctors and the health system.

This situation continues and is not getting better. Eliminating the loopholes that permit frivolous suits against doctors will minimize the financial incentives that some opportunistic attorneys exploit. It will lessen the moral distress that doctors and nurses labor under.

One way of doing this is to substitute “health courts” for the traditional adversarial-based system that is currently used. Health courts run on the principle that aggrieved parties are willing to settle differences in a reasonable manner without resorting to the underhanded and unnecessary adversarial methods used now. Using this method, patients would receive their compensation in months and not in years. The animosity between doctors and patients would be minimized. Such a system already exists in some Scandinavian countries.