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Is Medical Malpractice Academic?

Where a doctor attended school may predict future suits

TUESDAY, Oct. 7, 2003 (HealthDayNews) -- Where your doctor attended medical school predicts the odds that he or she will be sued for malpractice.

The connection between the diploma and the deposition isn't immediately evident, the researchers say. But an obvious implication of the work is that quality of early medical training bears on quality of care in practice.

"There is a link here," says study leader Teresa Waters, a health economist at the University of Tennessee in Memphis. "Do we understand it? No, but we find one."

Waters and her colleagues, whose study appears in a recent issue of Quality and Safety in Health Care, analyzed malpractice claims against 30,000-odd doctors practicing in Florida, Maryland and Louisiana between 1990 and 1997. Roughly 11 percent of the doctors were involved in a malpractice lawsuit during that time.

They also had access to where the doctors had gone to medical school and when they graduated. Only doctors trained in the United States were included in the study.

Previous studies have shown, not surprisingly, that a physician's specialty has a lot to do with the odds of getting sued. Obstetricians, surgeons and emergency doctors are among the most prone to malpractice claims, while primary-care specialists, internists and others face suits less frequently.

And the latest study bore out those findings, though it did not conclude, as other research has, that anesthesiologists fall into the high-suit category.

"Doctors who do things that are invasive are at increased risk" of lawsuits, Waters explains.

Intriguingly, the researchers say, certain schools were much more likely to have alumni named in claims than the average institution, while others fell at the opposite extreme. These schools, dubbed "outliers," typically didn't change their extreme status from one decade to the next: Schools with many sued alums tended to stay that way, while schools whose graduates avoided claims held that distinction over time.

What distinguishes these outlier schools isn't clear, Waters says. It could be curriculum, it could be the quality of the students they attract, or simply that they churn out varying numbers of specialists more prone to malpractice suits. Future studies could tease out the differences.

Waters' group did find that schools whose graduates were often sued tended to be public institutions and were more recently accredited. They also had more residents and fellows than schools whose graduates were seldom sued, perhaps diluting the mentor-student relationships.

The study named no specific schools.

Communication skills appear to be particularly important in preventing malpractice suits, Waters says. To the extent that a good rapport with patients can be taught, certain schools may do a better job than others in this regard.

Some experts speculate a link between medical school "quality" and malpractice suits is really a reflection of where a graduate goes for residency, for it's during residency, the argument goes, that fledgling doctors learn how to practice their trade.

Since top-drawer residency programs usually take their students from elite medical schools, these schools look good in comparison with lower-tier universities. Waters' group plans to study how strongly residency training is linked to malpractice suits.

Derek Weycker, a health economist at Policy Analysis Inc., a health research group, has studied the relationship between medical school attendance, residency and malpractice cases. His own research found doctors who attended highly ranked schools -- in the top 25 percent for U.S. programs and the top 10 percent for international programs -- get sued less often than those who attended less well-regarded institutions. Residency, however, didn't seem to be associated with suits.

One of the strongest predictors of being sued, Weycker says, is having been sued before -- and paid up. "Unpaid claims did predict subsequent claims, but claims that result in payment and physicians with multiple paid claims, then you're really talking about predictive ability," he explains

More information

For more on the quality of the nation's health-care system, try the Agency for Healthcare Research and Quality or the National Committee for Quality Assurance.

SOURCES: Teresa Waters, Ph.D., associate professor, Center for Health Services Research, department of preventive medicine, University of Tennessee Health Science Center, Memphis; Derek Weycker, Ph.D., senior consultant, Policy Analysis Inc., Brookline, Mass.; September 2003 Quality and Safety in Health Care
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