[ad_1] Behind most lawsuits against doctors lies a desire to correct past harm and deter future negligence. But malpractice litigation causes harm itself. This harm often persists long after a lawsuit is resolved, by quietly distorting how medicine is practiced -- in ways that make care less safe for everyone. I learned this the hard way. Twenty years into my practice as a critical care physician, I received my first malpractice claim. Three years later, I was ultimately cleared of any wrongdoing. But the process changed how I practiced medicine -- and not for the better. I became more guarded when seeing patients, spending less time thinking about their well-being and more time thinking about ways to protect myself -- like ordering more tests and documenting more obsessively -- rather than fully trusting my clinical judgment. I spent hours responding to legal questions and preparing for depositions, instead of updating outdated medication protocols or launching a new pulmonary program for an underserved community. For years, my mind was cluttered because I had trouble getting a clear understanding of the process itself, since few colleagues shared their experience openly. A malpractice system designed to promote accountability instead fuels defensive medicine, inefficiency, and silence -- conditions that undermine patient safety far more often than they prevent harm. A decline in trust between doctors and patients is the predictable result. Fear and anxiety develop in both physicians and patients because blame often fails to distinguish between a few bad actors and the majority who deliver high-quality care (adverse events are uncommon and are largely not the result of negligence). Guarded testimonies in court replace open, honest conversations at the bedside about what happened and why. Defensive care becomes common as doctors try to protect themselves by ordering more tests and consultations, which increases the number of appointments patients must attend and risks misunderstandings when doctors offer differing opinions -- fueling mistrust. Access to care is disrupted as well. Fears of damaging reputations, shame, and professional stigma can shorten careers and push doctors away from higher-risk areas like obstetrics and surgery, reducing access to these services. The result: patients may find it more difficult to find doctors they trust for the care they need. Medical malpractice also distorts the context in which physicians care for patients. Rather than improving conditions that make physicians more efficient and effective, institutions devote valuable personnel and financial resources to processing mountains of paperwork, hiring lawyers and experts, and preparing for trials -- often exceeding hundreds of thousands of dollars over years. Extra tests and services as part of defensive medicine raise costs and cramp operations, forcing patients to wait longer for care. Costs that cannot be absorbed -- including rising malpractice insurance premiums -- may be passed on to patients. Malpractice exacerbates system stress where little can be tolerated. Despite its popularity as a corrective guardrail, caps on malpractice claims have largely been ineffective. Caps appear to have a limited impact on day-to-day defensive medicine practices. They do not remove payout incentives. Analysis of malpractice caps in action -- including California's Medical Injury Compensation Reform Act (MICRA) and its recent revisions -- shows that adjusting damages alone cannot fix a system that still favors litigation over other means of accountability. A recent Health Economics study showed that malpractice premiums jumped by more than 20% for ob/gyn and general surgeons and 16% for internists when non-economic damage caps were lifted in several states. The risk is fewer doctors practicing where patients may need them most. Accountability works better when it emphasizes honesty over blame and improves care rather than skewing it. An upfront, expedited peer review process -- already familiar to most physicians -- fosters confidence in due process: it can applaud exemplary behavior where appropriate and steer more egregious cases of negligence toward the usual malpractice claim process (or facilitate restorative justice practices involving victims, perpetrators, and the community). Though the process usually does not involve patients directly, a diverse and select committee of experts could ensure that accountability is upheld fairly, constructively, and efficiently. To be sure, the practice of medicine can be dangerous, and it needs safeguards. Some physicians violate professional standards and harm patients. Patients face asymmetry of information and power, particularly those from marginalized communities. The discovery process of litigation can bring real wrongdoing to light, such as when cardiovascular surgeons allegedly performed unnecessary surgeries on patients. In such cases, malpractice litigation has merit. But a system that reflexively treats every adverse outcome as an accusation of fraud or misconduct prioritizes fear-driven care over trust-building, diverts attention and resources from developing better ways to care for patients, and disrupts existing healthcare operations that patients depend on. We need to build accountability through transparency and learning -- not stagnate in accusatory or defensive behaviors. An upfront, expert peer-review process would allow legitimate claims to proceed while preventing others from jamming the system. Patients and physicians both benefit from care that is trustworthy, accessible, safe -- and accountable. Venktesh Ramnath, MD, is a professor of medicine at University of California San Diego School of Medicine and a pulmonologist at UC San Diego Health, where he serves as medical director for critical care and telemedicine outreach. Please enable JavaScript to view the comments powered by Disqus. [ad_2] Source link : https://www.medpagetoday.com/opinion/second-opinions/120299 Author : Publish date : 2026-03-15 16:00:00 Copyright for syndicated content belongs to the linked Source.