1) “sorry works” is a really important concept in medicine now, i think–so much so that at my hospital, we are actively encouraged by our attendings (when there is a major medical error–I’ve seen one so far) to be honest, ‘fess up, and let the *&it fly where it may. Why? Because studies have shown that accountability and honesty go quite far in reducing malpractice cases–aside from being the morally appropriate, decent human thing to do.

2) “Complications” is a great read–I read it about two years ago and loved it. All med students should be required to read it so they know what they’re getting into, whether they’re going into surgery or not (I’m in Peds)…the world out there is raw. Don’t forget it.

3) Doctors do have methods of self-policing…if a really flagrant error (or even not-so-flgrant, to be honest), these things spread like wildfire through the hospital. When the “powers that be” are made aware (normally sooner rather than later), there are normally meetings and meetings–and if it’s bad enough, or has happened at a suspicious frequency, stuff starts happening: from warnings to suspension to being fired to having your license revoked. However, sometimes the system isn’t reactive enough–sometimes a LOT of “little things” need to happen before it’s brought up.

4) A random thought: how many times do physicians order tests not because they think something is really clinically needed, but more “just in case”? (Answer: VERY, VERY OFTEN) Think about how much money the system would save if we could just go with our gut instincts and eliminate the “cover your a___” tests?

But I don’t know anyone else… A meetup of three may be small but it’s a start.

didn’t realize there were mutineers in philly…since everyone else always suggests it, i’m gonna say it this time–philly meetup!

This isn’t unreasonable. However, don’t doctors already have their own processes for decertifying people? I really don’t know.

If they were to take an aggressive stance towards malpractice that included patients and others in the process, they might be able to reduce the anger that people have over the long run (kind of like alternative incarceration). The jury awards might go down by themselves then (and at that point the doctors could bitch out the malpractice insurance companies b/c the premiums would be out of whack with the jury awards).

Yes, I see what you mean. He favors them because they are technical and dispassionate, but one can imagine cases where it would be in their best interest not to be as rigorous as possible. Gawande, for his part, never says that he thinks that the threat of litigation should be taken out of the system, but rather that it should be coupled to a feedback mechanism that considers doctors as essentially ‘good,’ (committed ethical professionals), and aims to make them better than they were before rather than knock them out of practice. Information openness might also provide data at that could be used to improve the system as a whole (as has happened case of the cerebral palsy treatment centers Gawande talks about in one of the New Yorker articles).

BB, once you’re done moping about not being as big a rockstar as Atul Gawande, it would be interesting to hear your perspective on some of these issues

I haven’t read the book and don’t know the guy, but internal accountability measures rarely work as strongly in the interests of outsiders affected, in my opinion. For example, New York has no truly independent agency to monitor the police (it has the Civilian Complaint Review Board, which is a sham). I would imagine doctors would be a bit better, but not all that much.

I think the litigiousness of it all has to do more with the fact that people are constantly screwed over by insurance companies and the byzantine health care administrative procedures in the U.S. in general–and that includes doctors, patients, and everyone in between. Ultimately, the only way to solve this is probably to reduce paperwork, put medical decisions in the hands of medical professionals and their patients, and eliminate annoying middlement controls in favor of financial accountability measures that are not predicated on making sure insurance companies don’t lose any power.

Also, as a child of two doctors, I can tell you that it’s perfectly possible to be a caring and decent doctor even with the threat of malpractice hanging over your head. Neither of them were surgeons though.