A little while ago the New England Journal of Medicine published the results of a study that looked at thousands of paid claims over a 10 year period. The purpose of the study was to attempt to identify characteristics of the claims and the doctors who pay them in the hopes that those doctors could be reliably identified early on and provided resources to improve in ways that may avoid claims being made in the future.

The biggest takeaway, in my view, was this: “Approximately 1% of all physicians accounted for 32% of paid claims.”

Of course, this seems somewhat intuitive. But it is certainly not as simple as that. For example, risks of having to pay a claim go up or down depending on the type of doctor – all things being equal, neurosurgeons can expect to pay more claims than psychiatrists.

But the fact remains – there are some doctors who pay lots of claims. And the corresponding problem also remains – what to do about it? Is it possible to identify those doctors, provide them with tools to change, and avoid future claims?

I don’t pretend to have the answer to that question, but the report does consider at least one idea that can change and does have the probability of improving the odds of identifying those particular doctors, changing behavior, and improving patient safety (and consequently the number of paid claims).

And that is transparency.

This article notes that the current system (filing legal claims, settling or trying cases in court) is meant to improve the system by acting as a deterrent to future bad care, then states that, in that regard, it “performs poorly”.

I think one of the same reasons you can’t identify these doctors, and also why this system appears to “perform poorly”, is because of a lack of transparency.

Institutions and insurers of physicians who are paying claims take considerable effort to avoid anyone knowing who paid the claim or how much it was.

In settling claims, every single entity providing medical care in Washington State, including insurers of those physicians, with whom I have resolved a claim on behalf of my client, routinely pressures them into signing confidentiality agreements.

Similarly, institutions are loathe to report doctors to the National Practitioner Data Bank (NPDB). The NPDB was set up as a confidential database to improve healthcare quality. Institutions and insurers are mandated to report any claims paid above a certain amount. The purpose is to have a database available so that, if one physician has a number of claims paid, leaves the area and tries to go to some other city or state to find employment, hospitals considering hiring him or her will have access to this database and the knowledge of the doctor’s history of paying claims.

Doctors, understandably, don’t like this. And their institutions take great efforts to shield their doctors, finding ways to describe the payment as being made not because of the bad actions of the doctor, but about a systemic error, or an error made by another, often low level, provider.

This contributes to a national lack of transparency, which itself inhibits the ability of researchers such as those involved in this study from coming to meaningful conclusions that may result in increased patient safety.

There are not easy questions, for sure. But improving transparency is at least a meaningful start.

Read her for the full report:

[Prevalence and Characteristics of Physicians Prone to Malpractice Claims](https://www.nejm.org/doi/full/10.1056/NEJMsa1506137)