America is indeed a combative and quarrelsome nation. One only has to check the television lineup any day of the week to be treated to programs celebrating our fascination for lawsuits, lawyers and colossal jury awards.

The preponderance of legal drama shows on TV, and the numbers of lawsuits filed by Americans against other Americans for almost anything you can imagine, suggests that Americans prefer the ambience of a courtroom to almost anywhere else.

Now a report from the American Medical Association shows that Americans love to sue their doctors at the drop of a scalpel, and the practice seems to be increasing. In fact, however, it is enriching very few disgruntled patients, while significantly adding to our total healthcare costs.

The AMA report says as many as 61 percent of doctors over the age of 55 have been sued for malpractice at least once. The report found that 42.2 percent of all physicians were sued, with 22.4 percent sued 2 or more times. General surgeons and obstetrician-gynecologists were most likely to be sued (69.2 percent), family physicians and general internists were next at 38.9 percent and 34 percent, and pediatricians and psychiatrists were sued the least.

In a survey by the Journal of the American Medical Association, it was learned that 42 percent of physicians in high-liability specialties are fighting back the only way they can — eliminating procedures prone to complications, avoiding patients with complex medical problems or who appear potentially litigious, and ordering batteries of tests that might help absolve them of culpability in a malpractice lawsuit, but which otherwise they wouldn’t bother with.

Yet these figures don’t mean doctors are making more medical errors than ever. In fact, says the AMA, physicians win 90 percent of cases that go to trial, and 65 percent of the rest of the cases are dropped, dismissed or withdrawn before ever reaching trial — also leaving doctors in the clear. But the cost of fighting claims is high, averaging $22,163 to defend a case that is dropped, dismissed or withdrawn, on up $100,000 or more for cases that make it all the way to a courtroom.

To fight back, 73 percent of physicians practice defensive medicine — ordering additional tests to protect against potential liability and refusing risky patients or procedures , according to a Gallup Poll last February. The polled physicians estimated that 26 percent of healthcare costs were related to needless batteries of tests.  But meanwhile, a survey by Jackson Healthcare the same month showed that 92 percent of doctors practiced defensive medicine and estimated that it added up to 34 percent of health costs. And finally, a June, 2010, Archives of Internal Medicine report said 91 percent of physicians practice defensive medicine, and agreed that unnecessary diagnostic tests will never end until physicians are protected from unwarranted malpractice lawsuits.

What’s needed, says the AMA and the doctors, are changes in malpractice laws that will cap the massive awards often recommended by juries. Physicians have fought for medical liability reform for decades, and more than 30 states have implemented damage award caps. But in some states, including Illinois and Georgia, caps were recently thrown out by courts.

With $25 million in grants from the Dept. of Human Health and Services, state health systems are being asked to test alternative approaches, such as special “health courts”, early compensation offer programs and “safe harbors” — legal provisions that reduce or eliminate liability under the law. $50 million is designated for similar demonstration projects. Hopefully, these might lead to adoptions of a less financially onerous systems that will help reduce healthcare costs, and provide adequate and fair protection for both patients and physicians.

SOURCES: American Medical News, August, 2010, http://www.ama-assn.org/amednews/2010/08/16/prl20816.htm   http://www.ama-assn.org/amednews/2010/09/06/edsa0906.htm