Power Points
|
Anesthesiologists have got to be happy about all the good press they're getting.
In June, The Wall Street Journal published a complimentary piece on how the specialty has managed to shake off its once-risky reputation, with a payoff that
other specialties might be wise to take note of. Reported the Journal: By focusing on improving patient safety rather than on "laws that would protect them from patient lawsuits," anesthesiologists
have succeeded in lowering their malpractice premiums significantly—to the point where they "pay less for malpractice insurance
today, in constant dollars, than they did 20 years ago."
Other news outlets have also sung the specialty's praises, including this magazine. In our comprehensive med-mal report, published
this past January, we quoted California risk-management consultant David Karp, who said, bluntly: "If other specialists would
follow the anesthesiologists, you'd see a dramatic drop in claims, and, therefore, premiums."
Given how many doctors still pay sky-high malpractice rates, it would be nice to know there's a strategy out there for reversing
this trend. But does the anesthesiologists' model—with its emphasis on identifying the root causes of claims, finding technical
solutions to safety problems, systems analysis, and simulation training—really hold the key for reducing liability for other
specialties, including office-based primary care doctors? Or is there something so unique about what the anesthesiologists
do that their approach remains just that . . . their approach? We took a closer look to find out. Taking a hard look in the mirror
A patient-safety crisis hit anesthesiology even before the term entered the American lexicon.
By the early1980s, two in every 10,000 patients who went under anesthesia died, frequently because doctors had no reliable
ways of measuring things like pulse rate, respiration, and carbon dioxide levels. In 1970, nearly 8 percent of all closed
malpractice claims were against anesthesiologists, who even today make up only 4 percent of all US physicians. The number
of closed claims involving permanent disability or death was also disproportionately high during this period—about 64 percent—and
so was the number of closed claims with payment.
As a result of all this bad news, malpractice rates for anesthesiologists soared, especially during the med-mal crises of
the 1970s and early 1980s. In 1985, their average malpractice premium was $18,112, according to the American Society of Anesthesiologists.
In inflation-adjusted dollars, that's about 59 percent more than they pay on average today.
The rate crisis caught the specialty's attention. Like their colleagues in other branches of medicine, anesthesiologists wanted
their liability premiums reduced. "But key leaders understood that the remedy wasn't just about tort reform but about finding
better ways to take care of patients," says anesthesiologist David M. Gaba, associate dean for immersive and simulation-based
learning at the Stanford University School of Medicine.
For many, that meant taking a long, hard look in the mirror, admitting that patient safety was imperfect, and that the specialty
as a whole had to be enlisted in the turnaround if real progress was to be made. "Suddenly, you could make your career in
the anesthesia business as a safety expert," Gaba says. "Safety became a legitimate part of the overall endeavor."
Practice Tools
