"Malpractice" from the viewpoint of a plaintiffs' attorney

Lawrence Schlachter is a neurosurgeon who after 23 years in practice, was forced to stop operating because of a hand injury. He went to law school, became a plaintiffs’ attorney, and wrote a book called “Malpractice.” Although it is intended for patients, physicians might want to read it to learn something about how a plaintiffs’ lawyer thinks.

I’m not surprised that Schlachter cites the heavily extrapolation-based Journal of Patient Safety study claiming 400,000 medical error-related deaths per year and the thoroughly debunked Makary study claiming 251,000 deaths per year due to medical error. He does a little extrapolating of his own and comes up with 562,000 patients per year.

I agree with Schlachter about many issues. He says the best way to avoid becoming a victim of negligence is to take good care of yourself. If you need to be hospitalized, aggressively be your own advocate or have a relative or friend do it. You cannot assume that mistakes will not happen.

In several chapters, he says doctors should always be thinking of what could be the worst possible diagnosis a patient might have. Physicians should also be open to suggestions from other members of the team and should not be afraid to admit when they’re wrong.

He and I feel that doctors should look at their patients' x-rays and not rely on reports only.

A complication of surgery is not necessarily due to malpractice—a concept I have blogged about.

I once believed that much of the malpractice problem was due to frivolous suits, but have come to realize, as Schlachter explains, it can cost as much as $100,000 for a plaintiffs’ attorney to pursue a case. That money is only recovered if he wins.

We also agree on the definition of the term “standard of care” which is a moving target that can only be defined by a jury after hearing the opinions of plaintiff and defense experts. On the topic of experts, Schlachter acknowledges that experts for both sides are sometimes overzealous advocates for their sides.

He raises an interestring point. Medical societies and organizations have sanctioned many physicians for improperly testifying for plaintiffs but to his knowledge, they’ve never sanctioned anyone for doing the same for the defense.

Schlachter writes, “On average, every doctor will be sued once during his career. Yet we know the majority of doctors are never sued.” Do we really know that? According to a 2011 New England Journal of Medicine paper by investigators from Harvard, nearly every physician will face a lawsuit if she practices long enough, The figure below explains:

The paper analyzed the data by specialty. "There was significant variation across specialties in the probability of facing a claim, ranging annually from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry."

He devotes an entire chapter to the tale of reckless Texas neurosurgeon Christopher Duntsch about whom I have blogged. The book is laced with horror story anecdotes of many other neurosurgical cases that did not turn out well.

If you want to get a feel for what the book is like, read the piece he published today on the Stat News website.

Disclosure: I was given a prepublication copy of the book to review.