Tuesday, August 24, 2010

Tort Reform -Why Doctors Can't Say They're Sorry

Lately I’ve been doing some reading about the myriad of things in our healthcare system that we could be doing much better and as always tort reform comes out close to the top.

Looking at it, the problem doesn’t only lie in our rising medical costs due to malpractice insurance and doctors practicing defensive medicine (ordering probably unnecessary tests and treatment out of fear that they might get sued). It also erodes the trust present in the doctor-patient relationship and the integrity of the doctors forced to practice in a litigious atmosphere.

Doctors aren’t allowed to say “I’m sorry”. It’s a malpractice thing, kind of like the warning on the back of your car insurance card that says, in event of an accident don’t apologize. Apologies imply guilt, you see, and guilt means you lose in court.

The strange thing is that, they found (in a study I can’t lay my hands on right now), that if the doctor had only apologized, most of these lawsuits wouldn’t have happened. These lawsuits are brought to court by people in pain. People that have just lost a loved one, or a leg. People who believe that the doctor should be made to pay for what they’ve done since they so obviously have no remorse.

Can you imagine? I’m sure it’s happened to most physicians at one point or another, whether as a near miss or a true tragedy. One day you screw up. You’re too tired and you make a mistake during surgery, you misdiagnose a condition because the alternative just didn’t occur to you, someone dies or is horribly disfigured. And you can’t say, “I’m so sorry. I was tired. I didn’t think. I was human. There’s no way I could ever make up for your loss.”

What does that do to them as people? Doesn’t it make them feel like a monsters to cause a tragedy by making a mistake and then have to consider something so ridiculously pragmatic as whether or not the family will sue? How hard is it to go against their first instinct to try and ease these people’s pain and lock it down so that they can pray they don’t get sued. It’s a challenge with a million dollar price tag if they fail.

What does it do to the doctor-patient relationship when there’s a bad outcome and you know that even if your doctor was in the wrong they wouldn’t tell you? It sure makes it easier to assume that there was a mistake and a cover up or even true malicious intent, doesn’t it?

How did we get here? To place where people in pain use the legal system to punish people in pain? Who can fix this, really? What can we do? I don’t have the answers to any of these questions. Maybe someday I will. But for now I think we need to start by asking the questions.


  1. Well thought out post, Rachele. The other part of the insurance equation is the entitlement mentality many Americans seem to have developed over the last 20 or so years. In many cases when a mistake (or heck just an undesireable outcome) is made/reached, people see it at an open cash register drawer. They figure that insurance companies and hospitals are "made of money" and can afford some ungodly amount to 'recompense' them for their heartache.
    I'm NOT saying that damage is not done, or that there shouldn't be SOME monetary recovery, but these astronomical awards smack of winning the lottery. And that is NOT what insurance was supposed to be...

  2. I saw a clip from Scrubs last night, or maybe the night before...Where Dr. Cox went on a short diatribe about what is a doctor's job...and one of the first things he said was "patients are stupid", they're in pain, and they're afraid, and sometimes they want you to hold your hand...Or something like that. It ended up nicer than it started...but that first sentence just grabbed me. I am sure I've seen the episode before, but it has probably been years & years...and I have been through a lot medically in that time.

    Unfortunately, the attitude of "the patient is always stupid" is often how many patients are treated by their doctors! I've recently been treated like an actual human being by a doctor!! I was floored, lol! Many doctors have this, "I went to school, you didn't, so I know MUCH MORE about this than you EVER WILL, you're too stupid to even get it, I won't bother explaining it, so here's your presription, I hope you know how to read," attitude. That pisses folks off.

    It almost gives you the feeling like they're just waiting to screw you over so some insurance lawyer can tell you, "Well, that's what you get for being sick!" And in today's world...with the costs of everything, it almost feels like you have no choice but to sue for a big payout...b/c that's the only way the DOCTOR will feel a little bit of your pain. ...

  3. Maegan, you hit it right on the head. The problem is that most doctors do feel your pain (not saying that there aren't a few bad apples). I'm sure that the vast majority of physicians (who, keep in mind, got into this field to help people) feel agonizing grief when a patient dies. They just feel it at home with their families and out of the public eye. They're not allowed to share their grief with their patients so the patients assume that they don't feel anything at all.

    Keep in mind too, that a lot of these lawsuits are filed because of "undesirable outcomes" in which someone died or didn't get better but it wasn't anyone's fault (not that the doctors still don't blame themselves). People have such a high expectation of what the medical field can actually do(admittedly not helped by and partially caused by doctors themselves) that when it's their father or brother or wife that can't be saved it must be someone's fault. The third stage of grief is anger and blame. Sometimes people blame someone close to them, sometimes they blame God and sometimes they blame the doctors.