Physicians Learning About Law and Its Application at End-of-Life

Professor Sawicki writing a guest post at HealthLawProfBlog. “How Medicine Learns About the Law” offers insight into medicine and law. Specifically she speaks to malpractice and end-of-life. 

  • Physicians learn about law from friends, message board, media screaming heads. 
  • Physicians enter into medicine as Sawicki says ’scared straight’ fear driven.
  • Medical professionals fear of liability is unfounded. Though all physicians fear being sued. A 2011 NEJM study showed 75% to 99% of physicians had faced a malpractice claim by age 65. Sawicki points out engineers and architects face the same statistic. 

it’s important that medical providers have a more realistic perspective of how likely lawsuits against them are to succeed

Sawicki addresses areas within my wheelhouse, end-of-life and advance directive. She points out that physicians are pressured from families to over treat a no-longer competent patient even with an advance directive requesting no treatment. Why? Being sued. In her research she states:

… have not yet found a successful suit by a family against a physician for non-treatment in compliance with a patient’s prior wishes.

This struck me because there have been reports and articles that saw this differently: only 12% of patients with an AD received input from their physician and “65% to 76% of physicians with patients having completed an AD were not aware it existed. And the providers, family members, and surrogates did not meet the patient’s wishes for EOL management.” 

Other articles point to how physicians were only 65% accurate in predicting patient preferences and tended to make errors of under-treatment even following a review of the advance directive.

Professor Sawicki makes the point, the right result medically is the right result legally. What is medically right at end-of-life is the patient having their wishes met. Those wishes need to be set in place well before end-of-life and with an advance directive as well as identifying a trusted respected advocate. Carolyn and I spoke about this in Podcast #5 Advance Directive

Both the law and medicine need to step away from the crushing media bullshit on malpractice change and focus on patient wishes at end-of-life. We need to ensure patient wishes are patient reality.  

Malpractice Reform is Not a Cure to Our Healthcare Mess

I’m gobsmacked at how Aaron Carroll find, reads, and comments on as much as he does and how he takes a deep dive so succinctly. This is one example “Some sober thoughts on malpractice reform“. He read a manuscript in Health Affairs “Let’s Make A Deal: Trading Malpractice Reform For Health Reform

In part he quotes the following

To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals.

He further quotes from a key passage:

By contrast, decades of scholarship and empirical research suggest that malpractice liability acts only at the margin of health policy, where in relatively small ways it may both protect patients from negligent care and induce inefficient health care spending. (See the online Appendix for a more detailed summary of research on the malpractice system.) Physicians’ clinical decisions, on the other hand, are responsible for roughly two-thirds of total health spending. Physicians determine the quantity and quality of medical services and heavily influence the price paid for them. Research has revealed that far more of this spending is wasteful than can reasonably be attributed to liability pressure alone.

Check out Aaron Carroll, MD look at this topic, The Incidential Economist. He recommends reading the full article. It’s behind a pay wall and I am a cheap dude right now. But more importantly this is a new way to look at malpractice. A rather interesting and important step in this tort reform insanity.