Make no mistake: Risk control is cost control

September 1, 2008

Medicolegal issues in urology, discusses the impact of medical errors on the health care system and lists several goals designed to ensure your patients' safety.

While those within the medical field differ on how to improve the system, they share a common goal: to deliver high-quality, safe, affordable health care. Money spent on malpractice, whether for insurance or litigation, is money that is not being spent on the delivery of health care. Currently, medical and legal lobbyists are battling caps on awards to plaintiffs and tort reform at the state and federal levels.

An alternative approach would be to decrease the incidence of medical errors that cost the U.S. health care system billions of dollars each year. Lowering the number of medical errors decreases the likelihood of patient injury, leading to fewer malpractice claims and potential savings in insurance and litigation.

Costly mistakes

The doctor-patient relationship is at the heart of medical care. With competence and compassion, physicians gain the trust of patients to do what is right and to strive to avoid mistakes that can lead to harm. But the old dictum, "primum non nocere," ("first, do no harm") is easier said than done. Old notions that committed, caring doctors don't make mistakes are not only outdated, but wrong.

While physicians are rightly concerned with increases in insurance premiums and settlement claims, the staggering overall cost of health care in this country demands attention to the bigger picture. Two trillion dollars-16% of the U.S. Gross Domestic Product-was spent on health care in 2005 (Health Affairs 2006; 26:142-53). In recent years, articles have described the medical malpractice environment as a "crisis" (J Urol 2001; 165:1638-42; 2006; 175:1847-51; and 2006; 176:2154-7).

Although the actual number of claims has remained steady over the past several decades, the indemnity payment per claim has far outpaced that expected for inflation (J Urol 2006; 176:2154-7). But while the causes and solutions of the medical malpractice crisis are being debated, everyone agrees on the critical need to prevent medical errors.

Multiple studies have confirmed that humans and systems are prone to error. Improvements in the construction of systems and recognition and response to human error have markedly lessened the number of adverse events in the fields of aviation, nuclear power, and anesthesia.

The problem of medical errors was brought to the forefront with the Institute of Medicine's 1999 report, To Err Is Human: Building a Safer Healthcare System (National Academy Press, Washington, DC, 2000). The report estimated that between 44,000 and 98,000 patients in U.S. hospitals die annually as a result of medical mistakes. Other studies have estimated the cost of these medical errors at between $17 billion and $29 billion annually in the forms of disability, lost income, and additional health care costs.

The Agency for Healthcare Research and Quality is part of the Department of Health and Human Services, whose mission is to improve the quality, safety, efficiency, and effectiveness of health care. Other groups involved with patient safety include the National Patient Safety Foundation, the Leapfrog Group, the World Health Organization, the Institute for Healthcare Improvement, and the Centers for Disease Control and Prevention. Most of these organizations perform research on patient safety, act as patient advocates, and encourage patients to become better informed and to participate as partners in their own health care.

Studies show that fewer errors are likely to occur when patients are better educated and are actively engaged in their own care. Health care consumers are encouraged to talk candidly with their physicians and to ask questions to better understand their medical condition, treatment, and prognosis.