Attitudes Toward Medical Malpractice: A History

The first known case of medical malpractice involved a breach of contract litigation between a patient who sued a doctor that repaired a badly maimed hand, but did not meet expectations. The judge in that case set out some basic principles in medical malpractice:  If a patient is injured as a result of physician negligence, the physician is liable. However, simply being unable to heal a patient does not represent medical malpractice. The term "medical malpractice" wasn't coined until 1765 in England describing neglect or unskilled practice by a doctor that ultimately leads to harm.
Starting in the 1840s, malpractice lawsuits became more common as the physician started getting the blame for poor medical outcomes. Reasons for this included: the citizenry had discarded beliefs about God being in charge of poor outcomes, poor medical training, and also no medical standards.  The American Medical Association was formed in 1847 and began developing standards of medical care. The doctor's performance could then be measured against these standards which actually encouraged more patients to sue. Many patients began hoping for monetary judgments even if they did not actually believe the doctor was at fault.
Improvements in medicine fueled, and continue to fuel, malpractice lawsuits. Patients who before may have simply been thankful to survive, began to anticipate being cured, not just being happy to be alive -- being alive, but disabled wasn't good enough. Malpractice suits are likely when patient expectations exceed what medicine can produce. For example, lawsuits over obstetrics are considerably more common that litigation over geriatric medicine. Many folks acknowledge that modern medicine hasn't promised a cure for old age, but feel that a risk free delivery and a healthy infant is assured. Sadly, medical advances can lead to a rise in medical legal problems as patient become more demanding and unrealistic results are expected.

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Telemedicine: The Future of Urgent Care?

Telemedicine has proven useful in prison communities and rural areas, and a few providers are looking to the future with low cost telemedicine for nursing home continued care. Inadequate expert resources in certain regions have driven the market for telemedicine practices that can deliver expert care at lower prices. There's been numerous peer review papers published over the last 20 years that support clinical utility and the cost efficacy of telemedicine. Solutions to several of the technical challenges related to telemedicine are being developed to improve outcomes and lower costs.
Cloud-based applications like Virtual Health use video technology with virtual clinical services. A patient can connect with their physician by video portal, enter information about their health, and then clinical triage tools analyze the info to find out if an online visit is appropriate. Healthcare in the cloud allows health care organizations to get software options and the newest infrastructure and allows providers to economically adopt new technology as needed, increasing clinical capabilities cost effectively. A virtual health display refers to an interface revealing the patient's vital signs through a unit like Google Glass and could be utilized to monitor patients when the doctor isn't in proximity to the patient.
Telemedicine has been around for over two decades, however just recently has been more highly integrated into the healthcare system with digital physicians already playing a function in some rural settings in the usa, and in underdeveloped countries all over the world. Regulatory hurdles are playing an important part in slowing the pace of innovation and in keeping technology costs high. Current difficulties must be recognized by businesses and innovative health care alternatives developed in combination with health care organizations. It is important to be able to seamlessly and rapidly incorporate electronic medical records, biometric devices, and other info into both the user system and software for appropriate analysis. Telemedicine is an idea whose time has come. It holds the possibility of better use of scarce resources and improved access to healthcare.

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What are the origins of Medical Malpractice Litigation?

Laws in ancient Rome and Greece allowed doctors to be immune to punishment for actions committed for their profession. This was the status in Europe before 14^th century as well. The first recognized case of medical malpractice was in 1374 in London, England. A woman charged a surgeon for violation of contract. The woman stated that the doctor promised to repair her mangled hand for a fair payment, but did not do this. That lawsuit was dismissed because of  the wording of the complaint. However, in providing the judgment, the judge established some fundamental guidelines for medical malpractice – relating the case to treating a horse. He explained if a patient were hurt due to his negligence, that a physician could be liable for medical malpractice; however, if a good faith effort was made by the doctor, he would not be held liable, even if he were unable to cure the condition.
The initial recorded medical malpractice case in America took place just before the American Revolution. In that case, a woman called Cross, reported pain in her chest. The physician, Dr. Guthery diagnosed scrofula, a type of tuberculosis infection within the lymph nodes. Dr Guthery immediately conducted an amputation of the breast, but Ms. Cross suffered complications and subsequently hemorrhaged to death.  Doctor Guthery sent her husband a bill for 15 pounds plus his regrets. Her husband filed a lawsuit against Dr. Guthery and not only persuaded a jury to dismiss the bill, but also gave him 40 pounds as compensation for the lack of his late wife’s companionship. Therefore arose the marvel of medical malpractice litigation.

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Electronic Medical Records and Medical Malpractice Suits: Six Common Issues

Many physicians currently employ some kind of Electronic Medical Record (EMRs) and although many issues related to paper charts have been resolved, the EMR isn't foolproof. Some common ways physicians might get burned or even sued while using EMRs include: security breaches, password difficulties, meeting the standard of care, input errors, ignoring clinical decision-making support, and communication with the patient.
Passwords must be protected and secret to safeguard confidential patient data. Independent passwords for every employee will help determine someone that could be breaking workplace policies. Clear, well-defined guidelines regarding internet use and password defenses can minimize the chance for security breaches. If a security breach does occur, there is a legal and moral duty  to inform the individuals affected. HIPAA has created specific processes for notice to patients who have been potentially affected by a security violation of their confidential health information.
EMR alerts are created to assist the physician’s decision making process, but ignoring or over-looking these warnings could put the doctor and patients at risk. EMRs often report the total amount of time spent reading alerts thus speeding through them could be a major factor in a lawsuit. Standard of care concerns are also impacted by the usage of EMRs. Some EMRs have devices to inform about certain criteria or issues and not using the various tools provided within the EMR may result in lawsuits.
Input errors and sloppy records can be a road map for or, in the least, can raise concerns about competence in a medical malpractice situation, even if the mistakes or omissions had nothing to do with the results. Communication is another potential pitfall in that some patients feel the doctor is not listening or focusing on their issues, but instead on a computer.  Patients feeling too little connection to their doctor are more likely to sue.
There are lots of issues that could lead to litigation, although EMRs have tremendous potential to boost quality and continuity of care. Accurate and appropriate use of the EMR is essential to prevent litigation risks.

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Communication and Resolution Program Reduces Malpractice Lawsuits

In Massachusetts, a plan meant to create resolution and communication between patients and health care providers has resulted in fewer malpractice lawsuits. Under this strategy, the patient is required to notify the hospital or other healthcare provider of the intent to sue, but then has to wait 6 months before actually filing suit. This waiting period allows providers time to investigate and offer a response to the individual.

Many doctors and patients are finding this program a lot more acceptable than a lawsuit. Doctors frequently feel terrible about any harm done and having a chance to offer a heartfelt apology and clarify what happened is far more appealing than winning a lawsuit. Patients are often happier to get an apology than have to undergo a lawsuit, and often hospitals who realize they have made a blunder provide the patient a financial settlement. The primary motivation for medical malpractice suits is often not cash, but desiring to know why and what happened. Honestly discussing what happened and receiving an apology is often what's really desired. Another favorable side effect of this system is it allows a hospital to openly inquire what occurred, admit that a mistake was made, and also make changes to prevent similar errors later on, whereas, during a suit hospitals are unable to do this.

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Defensive Medicine: Tort Reform Does Not Address Concerns

Defensive medicine implies added or unnecessary services including: extra screening tests, needless hospitalizations, prescriptions, and procedures; all in the pursuit to reduce bad outcomes and decrease the chance of malpractice lawsuits. Defensive medicine is frequently reported as being a costly and unnecessary and could be reduced by lowering the amount of frivolous lawsuits. It's also regarded as one of many causes behind increasing health expenses, however its use is common. One study completed in 2009 by Jackson Medical Care, found that defensive medicine of some form was practiced by 92% of physicians questioned. A Gallop poll in 2009 found that 78% of doctors interviewed practiced defensively. The cost of defensive medicine is calculated at $650-850 billion dollars annually.

Tort reform was supposed to help reduce lawsuits and lower healthcare costs. Many states passed legislation to increase the standards for malpractice in emergency medical care, however, a recent study within the New England Journal of Medicine found that this had little impact on imaging rates, hospital admission rates, and average expenses. Physicians continue to view their risk of litigation as large and that practicing defensively will help reduce this danger. The truth that many malpractice claims are dismissed did not matter. Fiscal costs and the personal toll of malpractice lawsuits are extremely real – the average doctor spends almost 11% of a 40-year career with open and unresolved malpractice claims according to one study.

One suggestion to help restrict unsupported legal claims incorporates “safe harbors” to utilizing evidence-based guidelines in practice. These guidelines will be hard to establish with many contradictory recommendations around. Development of practice guidelines for safe harbor protection will soon be extremely challenging, but has the potential to benefit both patients and providers, which has not been the case with existing tort reform efforts.

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Failure to Vaccinate!

The recent outbreak of measles has spread to eight states and infected almost 100 individuals. Measles is an airborne virus that infects almost 90% of those which are unvaccinated if they are exposed. Many vaccine preventable diseases have dwindled through the years so parents have less understanding of the devastating results of these illnesses and, as a result, are more inclined to concentrate on potential adverse effects of vaccination. Unfortunately, deceitful studies, celebrity opinion, and anecdotal evidence, frequently repeated by the media, have gotten lots of people to jump on the "anti-vaccination" bandwagon. Children can receive an exemption for religious or philosophical beliefs, or medical exemptions although vaccinations are supposed to be required to enter school in the USA. Forty states now permit philosophical exemptions and those states have a higher vaccine exemption rate than states that simply allow religious exemptions. They also have a higher rate of the illness.
In 1998, the measles-mumps-rubella vaccine (MMR) came under fire after a small study supposedly illustrated damage to the intestinal lining causing autism. This study was retracted in 2010 and attested to be fallacious in 2011. But, the media reports and hearsay continue to feed this inaccuracy. The risk of an adverse event associated with a vaccination is slight. The danger of acquiring measles for an unvaccinated person during an outbreak is nearly 35 times that of a vaccinated person. The disease is preventable by vaccination.

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Truth vs. Believability of Expert Witnesses

The truth should always be the main factor in the outcome of a legal case. In reality, we as individuals, frequently make decisions based on who seems believable, honest, or motivated. Jurors base their decisions more on courtroom drama and who appeared believable or most genuine, than on scientific facts and figures and often do not understand the facts. Thus, when choosing an expert witness, factors such likability and trustworthiness, confident body language, and speaking with authority are just as, or more, significant than real expertise. Witnesses who will speak with warmth and make an attempt to spell out the facts in a way a layperson can comprehend are crucial in winning a case. Expertise and credentials are required to allow the expert witness to testify, but play merely a minor role in persuading juries. Some believe that the current legal system in which each side pays and gets expert witnesses, enables the facts to become unimportant in the decision making process. Some have even suggested that so as to rebuild the value of facts, expert witnesses have to be appointed by the court to simply present and clarify the facts.

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