How Can We Avoid Bad Doctors?

The New England Journal of Medicine recently published, Prevalence and Characteristics of Physicians Prone to Malpractice Claims, stating the major problem with medical care in the USA.

If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them before they accumulate troubling track records would be valuable. Attempts to predict malpractice claims have had mixed success and suggest that prospective identification is not feasible. This helps to explain why the medical malpractice system remains largely a reactive enterprise, focused on the aftermath of care that has gone wrong. The chief contribution of the system to the prevention of harm lies in its intended role as a deterrent to substandard care — a function that evidence suggests it performs poorly.

Well, what can be done to fix the problem? The authors claim:

The National Practitioner Data Bank (NPDB) is a confidential data repository created by Congress in 1986 to improve health care quality.

This is nonsense because the NPDB exists so that insurance companies can offer prices to doctors for medical malpractice insurance. If the purpose were to improve health care quality, the data would not be confidential. If it were open to the public, many patients would avoid doctors who have been named as defendants in malpractice suits. The data is confidential because doctors protect bad doctors just as teachers unions protect bad teachers and police unions protect rogue cops.

If you receive poor service from a plumber or electrician, you can write a review on Angie’s List, and you can write about your experience in a restaurant on Yelp, and you can write a book review on Amazon; but doctors own the government and have exempted themselves from the free market. Opening the NPDB to the public would be especially useful because medical malpractice lawyers file suits only in special cases. Lawyers receive many inquiries from angry patients and only accept clients whose cases against doctors are easiest to prove.

Consumer’s Union states:

Consumers Union’s Safe Patient Project released a statement calling for public access to information in the National Practitioners Data Bank (NPDB), a federal agency that collects information on problem doctors with a history of sanctions by state medical boards and hospitals and lawsuit payouts for harming patients.

A Consumer Reports national poll found that almost 9 in 10 Americans (88%) said the public should have access to federally collected information about problems with doctors.

Most doctors do not have a history of problems, but consumers have no way of distinguishing those who don’t from those who do. Hospitals, insurers, state licensing boards and other health care entities have always had full access to the information in the Public Use Data File, including doctors’ names. We think patients should be given the same access – and most Americans agree with us. There is no rational reason for keeping such information secret.

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