My solution to medical malpractice crisis
If you live in Illinois, you’ve heard about the debate in the State Senate on medical malpractice rates. It seems that doctors are leaving the state due to high malpractice insurance rates. Predictably, the insurance industry and the AMA say that awards should be capped, while patient advocacy groups say that hospitals and the law need to do more to weed out incompetent doctors.
They’re both only a little bit right.
There are certainly absurd damage awards, but also incompetent doctors, and even greedy insurance companies who blame equally greedy patients. And the law, in its clumsy way, could make some kind of rough correction to it all. Might I suggest a different model? 
How about eBay’s feedback system?
If you have not used eBay, here’s how it works: buyers comment on their experience with sellers, and sellers get a rebuttal comment (if they want one). The total percentage of good and bad comments is openly displayed, and prospective buyers can peruse the seller’s total library of comments.
Doctors, hospitals, and clinics are sellers; patients are buyers.
The system is rather brutal, but it would weed out the bad doctors faster than you could yell “Falling malpractice insurance rates.” No legislator would have to lift a finger; in just a few months, a pattern would begin to emerge. Layers of official denial and obfuscation would be stripped away to open up the truth about which doctors had satisfied patients and which did not.
Every doctor has some dissatisfied patients, along with some irrational devotees, and readers could judge the credibility of those patients’ claims. A legal framework of protection would have to be built for the comment system to ensure patients (buyers) have the opportunity to speak freely. If a patient is really off-base, the doctor has the option of responding with a rebuttal comment if he wants. In any case, the computer-generated percentage reflects the totality of all patients.
Most attractive feature for me: doctors, clinics, hospitals, lawyers, and the insurance industry would all hate it.
Have we not visited some perticular xyz doctor just ‘coz he cured our neighbour’s uncle’s son….i think the word of mouth works as good as e-bay in the local community as we can see and face the doctor !!
E-Bay needed the feedback system as its users were too spread out to be able to interact with each other
Sounds nice, but it wouldn’t work. Doctors would feel obliged to either spend a lot of time rebutting frivolous (or worse) feedback or file libel suits.
And if a disgruntled (rightfully so or otherwise) has to choose between a feedback statement in cyberspace or the potential of a juicy settlement, what do you think they’ll choose.
What we need are medical governing bodies that do their job of improving doctors’ skills and results, rather than protecting their own. Perhaps cash incentives to medical societies based on those falling insurance rates would be an interesting idea.
Abster, the model you propose would work OK in a village, but not in a city. Any doctor or surgeon I use will have hundreds of patients and I don’t know any of them.
WeeDram, this proposal sounds nice? It’s the opposite of nice – it’s brutal. But that is exactly what is needed. Patients wouldn’t have to choose between feedback and lawsuits – they could do both. And the legal space carved out for the feedback could confine comments to “this was my experience,” which isn’t libel. Cut their comments to 500 words plus a check-off survey and they’ll stick to essentials.
People share their doctor experiences now (as Abster suggests) but this would only be a way for them to do it with more people.
When someone’s going to carve on my body or prescribe meds, I’d love to see feedback from their other patients. I bet doctors would start listening to their patients a LOT more carefully. They’d spend more time with their patients and yet malpractice costs would go down because bad doctors would have empty offices. The marketplace would do what no regulation possibly could.
Unfortunately, the model depends upon patients being able to change doctors. Thanks to HMOs, preferred provider plans and falling Medicare/Medicaid reimbursement rates which have resulted in doctors refusing those patients, many people just don’t have that luxury. Ditto small towns with just 1 or 2 clinics.
FWIW, the state of Washington is introducing a rating system for nursing homes very similar to this, though.
This kind of reminds me of Rate my Professor.
As the fraction of uninsured grows, I wonder what effect that has on the whole system. Would self-pay patients be more selective and cost-conscious?
Well, maybe nice wasn’t the best choice of words. I meant that it “sounded” like a reasonable solution to the problem. And the points you make about the value of feedback to other prospective patients, the potential for doctors to be more attentive to their patients, etc., are certainly quite possible outcomes.
But I still don’t think it would work all that well. I’d love to be wrong, so a trial of some sort would be interesting.
And yes, there are rating systems already in place in some jurisdictions for certain sectors of the health care “industry”. Here in NY I believe there is a website which gives such information, but it’s not a wide open forum, and I don’t recall how the information is collected, summarized, etc. That clearly affect its value.
In Ontario the malpractice lawsuit problem is not nearly what it is here. There are likely lots of factors, but I don’t really care. I just want to move back, to a decent universal health care system.
WeeDram
Further to the discussion, and my comments about the Ontario healthcare system: <http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1117231811479&call_pageid=968332188492&col=968793972154&t=TS_Home&DPL=IvsNDS/7ChAX&tacodalogin=yes>
One of the caveats I have with the feedback system is the lack of independent expertise. In the issue cited in this Toronto Star article, the government will introduce legislation that enforces the use of expertise, makes the system more transparent and more effective. I hope.
WeeDram
“Every doctor has some dissatisfied patients, along with some irrational devotees, and readers could judge the credibility of those patients’ claims.”
I don’t think you can dismiss this problem so easily. How should a reader judge the credibility of a rating? It would invariably come down to one person’s word against another.
Part of why the e-bay system works is because of the anonimity. The buyer has not met the seller, and so has no reason to either love him or hate him. It allows for objective feedback.
Doctors are in contact with their patients every day, and this will lead to biased feedback. And unfortunately people with an agenda are going to make themselves heard.
To give an example of how this could give skewed results: Say a doctor is not especially good. He’s not bad either, just average. But he is incredibly nice. He has charm and charisma and all his patients love him. His ratings will be disproportionately favorable, despite the fact that someone looking for a new family doctor would probably want to keep looking.
I remain utterly, completely unrepentant, unconvinced, unswayed by objections to this idea. Any prospective patient will look through the comments and see patterns emerging. The mix of good and bad comments will give patients a little perspective – and some leverage – that they do not have now.
Try Googling the phrase ‘iatrogenic deaths’ for a glimpse of the scale of the problem. I would accept as axiomatic that five or ten percent of doctors are responsible for eighty percent of them. Those doctors’ comment profiles will look very different from the rest.
Many patients sue their doctors only because they have no other way to be heard. If someone is going to cut into you with a knife or prescribe potentially fatal medicine to your child, wouldn’t you like to see the comments of his other patients and compare to other doctors?
The medical profession appears unable to identify its most careless members. If it drives the worst 5 percent of doctors right out of business, well that’s just ‘hard cheese’. The rest would almost certainly enjoy much lower insurance rates as a result and patients would enjoy better care.
It would also utterly dismantle the myth of the doctor’s godlike powers. Even the best doctors make mistakes and they’d be out there for everyone to see. Consumers would know that no matter how good their doctor is, they must still be informed and active in their own care.
If the objection to this idea is any variation of “people are too dumb or biased to share what happened to them as consumers of medical care” you’ll have to do better to convince me.
Its an interesting debate. The fact is that in a litigious society like the United States, Doctors are always going to need Medical Malpractice Liability Insurance.
People sue. That’s it.
Not sure an ebay system would work. What happens if the patient has mental problems!?
Hank
Oh, this is funny. You sell medical malpractice liability insurance and felt the need to defend your turf. Nothing I said would do away with malpractice insurance. Do you like insuring bad doctors? Wouldn’t you prefer insuring good doctors instead? Surely they’re more profitable.