October 26, 2007

There is a fascinating article on the front page of the Wall Street Journal today chronicling one doctor's rise and fall as an expert witness for plaintiffs against his fellow obstetrictians. The nub of the article hinges on the ubiquitious use of fetal heart monitors during birth, and whether misreadings of the device may cause doctors to overreact to apparent signs of fetal distress:

Obstetrics is one of the most sued medical specialties in the country, and its doctors shoulder some of the highest malpractice-insurance costs. "Fetal monitoring has become one of the tipping points in the evaluation of medical-malpractice cases," Dr. Schifrin says. "It's not the only factor." He calls his expert-witness work "the greatest education of my adult life."

Dr. Schifrin has testified against other doctors hundreds of times in the past three decades. In 2004, the American College of Obstetricians and Gynecologists censured Dr. Schifrin, for testimony he gave in a malpractice case. He later resigned from the organization.

The question the article doesn't answer is whether or not the use of fetal monitors is itself is an outgrowth of litigation pressures, i.e., whether doctors resorted to pervasive use of monitors to try and shield themselves from claims they didn't intervene soon enough when the fetus was in distress.

Now, the way our medical malpractice system works, doctors are sued when the plaintiff's counsel think they have a lucrative case, not necessarily when the doctor actually did anything wrong. For more information on how medical malpractice litigation can distort medical practice and one potential solution to the problem - dedicated medical courts - check out Philip Howard's excellent organization Common Good.

Posted by Paul Howard at October 26, 2007 10:27 AM

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