A lot of doctors favor tort reform — limiting patients’ right to sue — as a way to reduce the cost of malpractice insurance. There’s also a tendency to order unnecessary tests to cover themselves in the event they are sued, something often called practicing “defensive medicine.” Both are sometimes cited as a reason U.S. healthcare costs are so high, but in reality those costs are a small fraction of the total. (It isn’t insurance industry profits and executive salaries either, though the unbelievable complexity of U.S. health insurance and billing does add a huge amount of waste to the system.)

But malpractice costs aren’t trivial either, and here pediatrician Aaron Carroll (who has an obvious personal interest in the topic) describes research going back decades that shows that what really helps reduce malpractice costs, much more than tort reform or defensive medicine, is communicating better with patients. That, and being honest with them.

See also Dr Carroll’s article on the subject for The New York Times.

Incidentally, years ago I read that anesthesiologists has once had some of the highest malpractice insurance rates of all doctors but had managed to get those costs greatly reduced. They achieved this in a very clever way. They got together and decided to figure out how to kill fewer patients.

Speaking of being honest with patients, back when I was in the Navy and stationed in Charleston SC I had wisdom teeth so severely impacted that two dental surgeons performed oral surgery on me. It was so complicated they ran out of hands and I volunteered to run suction myself. (This was under local anesthesia.) At one point the guy with the scalpel said, “Oops.” I said, “Ooh?” He said, “I just cut a little more than I meant to. I’ll have to give you a couple of stitches.” He then admitted he probably shouldn’t have said “Oops” and told me he used to have a dental assistant who would say things like “Ooh, Doctor, look at all that blood!” OK, maybe it’s possible to be too honest.

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