The Culture of Fear and the Emerging Culture of Patient Safety

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Many in the medical community are advocating for increased transparency and full disclosure of information as a way for doctors to affect change from within the health care system and reduce the frequency of malpractice suits. Currently, many doctors are hesitant to share information with colleagues, which means that information about previous medical treatments may not be available in emergencies and incident reports are frequently buried or kept private.

Instead of using records and patient information, many doctors practice defensive medicine and order up a variety of unnecessary tests, consultations and procedures as a means of protecting themselves from malpractice liability. For example, the Massachusetts Medical Society reported that 83 percent of physicians surveyed practiced defensive medicine, with an average of between 18 and 28 percent of all tests, procedures, referrals and consultations ordered solely for defensive reasons.

Moving from a Culture of Fear to a Culture of Patient Safety

Despite the prevailing culture of fear that dominates the medical profession, the Centers for Disease Control and Prevention estimates that there are at least 2 million hospital-acquired infections each year and that these infections lead to approximately 90,000 preventable deaths. In addition, they estimate that medication errors harm more than 1.5 million people each year, with 400,000 of those errors occurring in hospitals.

According to a new report published in March 2010 by the Lucien Leape Institute at the National Patient Safety Foundation, “Achieving safety in the work environment requires much more than implementing new rules and procedures. It requires the development and sustainment of cultures of safety that engender trust and embrace reporting, transparency and disciplined practices.” The report pressed for a complete overhaul of medical school education, including a change of emphasis at the admissions level and “selecting for attributes that reflect the concepts of professionalism and an orientation to patient safety.”

The New England Journal of Medicine offered additional recommendations beyond educational reform for changing the culture of fear, focusing on “emerging models of disclosure of medical injuries and early resolution of cases.”

According to a report issued by the RAND Corporation, “improving performance on 20 well-established indicators of medical safety outcomes” reduced medical malpractice claims. Instead of protecting information and keeping it private, liability insurers can use the information gathered to improve patient safety, identify dangerous procedures or conditions and share that information with other health care facilities.

Impacts on Medical Malpractice Lawsuits

Certain policy measures could usher in a swifter demise of the culture of fear and stimulate more widespread adoption of private malpractice reforms. But despite President Obama’s recent call for alternative measures to resolving medical malpractice suits and a move to electronic medical records, little is being accomplished.

Still, several hospitals and numerous medical schools have already begun undertaking massive changes even before mandatory reforms or legislation. For example, the Veterans Affairs hospital in Lexington, Kentucky, has already instituted a disclosure and offer approach where the institution accepts responsibility for the medical injury and offers a predetermined limit of $25,000 for out-of-pocket expenses and up to $5,000 for loss of time.

With politicians proposing and debating numerous policy mechanisms, it is difficult to determine exactly what impact there will be on medical malpractice lawsuits. But reducing the culture of fear that permeates the medical profession should help to reduce both health care costs and the frequency and severity of medical malpractice suits.


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