Ounces of malpractice prevention

The source of malpractice claims, contrary to widely held views, is not simply improper or inadequate medical care. In the majority of cases, malpractice litigation ensues because of negative nonclinical factors and the incidence of an unexpected result in medical treatment. High on the list of nonclinical causes are faults in the physician-patient relationship. Patients who are unhappy with the manner in which they have been treated by physicians are much more likely to sue when the outcome is even moderately untoward. Key to reducing the incidence of malpractice suits is helping physicians understand that attention has to be paid to their behavior.     

Clinical guidelines: a defense in medical malpractice suits

Clinical pathways, or practice guidelines, have been gaining wider acceptance from physicians and hospitals seeking to constrain increasing operating costs for inpatient care. The authors believe that properly developed and agreed upon guidelines can also be used in certain cases as appropriate standards of care in determining if medical malpractice has occurred. Adherence to the guidelines could then be asserted by defendants as an affirmative defense in a medical malpractice suit.     

Long-term solution to malpractice crises: reduce harm to patients

Physician executives need to lead the charge and actually reduce harm to patients. Simply capping malpractice awards or changing the rules of litigation is not enough.     

The implications of practice guidelines for physician medical malpractice liability

Medical practice guidelines are increasingly coming into use, and as more and more physicians are presented with guidelines to follow in the delivery of health care, the question arises of whether these guidelines will become instruments for imposing greater medical malpractice liability on physicians. This column will briefly describe what guidelines are, how they are developed, and how they have been and may be used in litigation against physicians, hospitals, and other health care institutions. As hospitals and managed care organizations continue to implement guidelines, the role these guidelines play in malpractice cases can be expected to increase. It appears, however, that, although guidelines will contribute to the establishment of the standard of care by which a physician's actions will be measured, they are not likely to become the standard that all physician treatment decisions must meet.     

Clinical practice guidelines and medical malpractice

As clinical practice guidelines become more and more prevalent, they will define the requisite "standard of care" for medical treatment and impact medical malpractice litigation. They may even replace expert testimony.     

Scared silent: the clash between malpractice lawsuits & expert testimony

As the Bush administration pushes Congress to place a $250,000 cap on pain and suffering awards in medical malpractice lawsuits, other moves quietly afoot by state medical boards, state medical associations, and specialty societies may reduce liability insurance premiums by limiting the number of suits.     

Constitutional rights versus malpractice insurance settlements

The increasing costs and complexity of malpractice litigation have created an statutory right that allows malpractice insurance companies to settle malpractice claims regardless of the desires of the defendant physician. In the past, the consequences of settling a malpractice claim out of court were not as important as they are today. The Health Care Quality Improvement Act of 1986 mandates that any settlement in behalf of a physician be documented in the National Practitioner Data Bank (NPDB), which must be consulted every time the physician is credentialed. This NPDB requirement denies due process to health care providers and thus becomes a violation of the federal and many state constitutions. Physician executives and medical leaders must bring these issues to the table and negotiate solutions before damage to practicing physicians and the U.S. health care delivery system caused by this legal paradox become too severe.     

10 ways to reduce medical malpractice exposure

Communicating with patients, keeping accurate records and actually taking time to examine patients are three of the top 10 ways to avoid a lawsuit. Find out more in this article by a doctor who's reviewed over 200 malpractice cases.     

Stress management can lead to reduced malpractice.

The prevention of medical malpractice is not an easy task. There is no one factor that can be said to be the "cause" of malpractice claims. Many areas have been targeted for concern--interaction between an individual professional and the patient, interaction among members of the professional staff, use and outcome of the application of medical technology, management practices, occupational environment, level of education and training, and personal coping styles. Although the degree to which attention to stress management techniques can be expected to reduce malpractice claims is unclear, it seems certain that attempts to alleviate occupational stress would be productive.     

Professionals in Medical Settings:

Selected literature is reviewed to illustrate the causes and effects of stressors in various medical professional groups. In general, the common stressors faced by medical professionals appear to result from the interdependent nature of the jobs in the hospital or medical settings, the individual's sociocultural background and personality. Individual characteristics moderated the relationship between stressors and stress symptoms. Job and role-related stressors were consistently related to distress, or negative consequences, while positive work relationships and social support appeared to decrease distress. Directions for future research areas are discussed.     

Self-help for stress and burnout without therapist contact: An online randomised controlled trial

Interventions designed to reduce stress and burnout may be costly and access is limited. This study examined the effectiveness of a self-help book, using Acceptance and commitment therapy (ACT) to target stress and burnout in a randomised controlled online trial without any therapist contact. Participants were recruited through a newsletter of a health insurance company. Participants (N?=?119) who reported at least moderate levels of stress were randomly assigned to an immediate intervention (n?=?61) or a waitlist group (n?=?58). Measures before and after the intervention assessed stress, burnout (primary outcomes), depression, well-being, emotion regulation (secondary outcomes) and ACT-specific constructs. Compared to the waitlist group, participants in the immediate intervention group reported lower stress and burnout and higher psychological flexibility at post-assessment. Effects between groups were large for stress (d?=?0.9), moderate to large for burnout (d?=?0.5–0.8) and large for psychological flexibility (d?=?0.8). All primary and most secondary outcomes and ACT processes continued to improve in the 3-month-follow-up period. Results suggest that an ACT self-help book without any therapist contact is effective in reducing stress and burnout for various occupations. Thus, it may provide a cost-effective public health intervention for reducing stress and burnout.     

Medical capacity investment for epidemic disease: The effects of policymaker's confidence and public trust

Due to the server bed shortage, which has raised ethical dilemmas in the earliest days of the COVID-19 crisis, medical capacity investment has become a vital decision-making issue in the attempt to contain the epidemic. Furthermore, economic strength has failed to explain the significant performance difference across countries in combatting COVID-19. Unlike common diseases, epidemic diseases add substantial unpredictability, complexity, and uncertainty to decision-making. Knowledge miscalibration on epidemiological uncertainties by policymaker's over- and underconfidence can seriously impact policymaking. Ineffective risk communication may lead to conflicting and incoherent information transmission. As a result, public reactions and attitudes could be influenced by policymakers' confidence due to the level of public trust, which eventually affects the degree to which an epidemic spreads. To uncover the impacts of policymakers' confidence and public trust on the medical capacity investment, we establish epidemic diffusion models to characterize how transmission evolves with (and without) vaccination and frame the capacity investment problem as a newsvendor problem. Our results show that if the public fully trusts the public health experts, the policymaker's behavioral bias is always harmful, but its effect on cost increment is marginal. If a policymaker's behavior induces public reactions due to public trust, both the spread of the epidemic and the overall performance will be significantly affected, but such impacts are not always harmful. Decision bias may be beneficial when policymakers are pessimistic or highly overconfident. Having an opportunity to amend initially biased decisions can debias a particular topic but has a limited cost-saving effect.     

Medical resource allocation: rationing and ethical considerations--Part I

The United States' system of high-quality but expensive and poorly distributed medical care is in trouble. Dramatic advances in medical knowledge and procedures, combined with soaring demands created by growing public awareness, the cost of private hospital and medical insurance, and Medicare and Medicaid, are burdening the medical care delivery systems. The costs of medical care have reached levels that can no longer be sustained. Government officials, insurance planners, labor leaders responsible for union health care benefits, and ordinary citizens are questioning whether it is acceptable to limit health care based on economic considerations. If health care is deemed a social good, the method of allocation must be addressed. Unless society decides that other priorities of the infrastructure are to be subjugated to health service delivery, difficult decisions will be forced upon us, consciously or by default. The discussion in this two-part article explores the ethical considerations of the more formalized approaches to resource allocation that presently exist in our society.     

带保修期的寿命型产品多属性招标采购机制设计——以大型医疗设备为例

产品的期望寿命是重要的质量属性之一,事前不可观察且不可验证,直接对该质量属性进行投标没有意义。针对此问题,以大型寿命型医疗设备招标采购为例,利用拍卖机制设计理论建立了一类具有信号传递功能的多属性招标采购模型。模型确定了最优投标规则,包括设备最优期望寿命投标、最优保修期投标与最优价格支付。模型确立了甄别投标企业技术类型与传递产品质量可靠性信息的机制。研究结果表明:首先该机制满足参与约束与激励相容约束,投标企业分别按自身期望利润最大化进行投标;其次该最优机制能保证企业承诺的保修期与期望寿命正相关,能保证技术类型最高、所提供产品期望寿命最大(保修期最长)的企业中标,并且中标企业创造相对来说最高的社会福利。构造一个算例说明新的多属性招标采购机制在实践中易于操作,是可实施的。当质量指标存在不可观察和不可验证的维度时,相关研究为解决多属性招标采购问题提供了一个新思路。