:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Tuesday, February 15, 2005  


Alot of folks have balked at the idea of me not carrying mal-practice insurance. my friends who love what i'm doing and want to join are held back by this concern. perhaps they are right, only history will ever know and it will only ever be known if some of us try it.

which, by the way, richer more powerful doctors than i are doing just that. there's a large group of OB-GYN docs in florida who have been without coverage for 5 years without a single lawsuit if what i've heard recently is correct.

so i'd like to lay out my understanding of the forces and realities of mal-practice insurance for those interested. i'm not unaware of the possibility of someone "crazy" suing me for cause or without justification but in the balance, i feel like i am more likely to be bitten by a shark or killed in a nuclear war sparked by oil greed or religious intolerance.

for me, malpractice insurance represents a big fat target for frustration and cynicism. the very act of having it invites lawsuits. this dynamic, i've seen in action. patients may even love you as their doctor, but they feel they are "sticking it to the man" by getting money from a big old greedy insurance company, and guess what, they need that money to pay their outrageous medical bill and future medical costs.

when i moonlight in other people's systems where the culture is adversarial, i carry malpractice insurance (particularly in ER's). for my practice, the pace, context, setting, fair costs, fair payment options, depth of relationships, community presence, time spent, etc are all forms of mal-practice protection.

bottom line is that we all do "mal" practice, we all make mistakes in this work. and we all need protections, but is malpractice insurance really protection? research shows that apologizing is a powerful form of mal-practice protection, but if you have mal-practice insurance or are part of an HMO or mega-system, you will be advised not to admit fault! who does this protect? who is harmed? i apologize when i mess up, it's a basic form of courtesy.

people are good but when you lie to them, when you are arrogant or perceived as arrogant and uncaring, they fight back.

do you have a way to hear your patients when you have messed up? can you apologize? can you refund their money? can you fix the error? can you use the mistake as a learning opportunity for yourself, your staff, the patients empowerment? are you defensive or open?

here's another angle to consider... i'm working with hard working people most of whom would be categorized as poor. i'm also working with substance abuse addicted individuals and refugees from the public health care systems like medicaid and county indigent health plans. most of these folks do not sue, they are frustrated and tired of the run-around and just plain thankful to have someone who listens and helps them make a plan of action, which sometimes actually includes joining in a discrimination lawsuit or such against one of the mega-systems...

so there it is. and i'm not alone. others have found this source of sanity. it requires a shift in how one sees one's relationship to the patient, it requires some savvy financial planning and frankly, some faith in our fellow humans. and just remember, this isn't legal advice, if you choose not to have mal-practice insurance and you get sued, don't go blaming me! take responsibility for your own choice - enjoy the freedom and live with the consequences.



posted by andru | 2/15/2005 07:53:00 PM | |


Thank you for answering my question. I pray that you will be safe as you continue to do what is right for the people you serve, and be successful in your mission to achieve health justice in our fragmented system. Good luck!

# posted by Anonymous Naia : 2/17/2005 8:43 AM  

I found this post to be incredibly interesting given our current debate about tort reform, malpractice insurance, and medical costs. Blogged you along with some related articles, and I hope to find more. Thanks for the explanation, & please keep posting!

# posted by Blogger Saheli : 2/23/2005 11:21 AM  

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