Sunday, January 24, 2010


Medical Errors and Malpractice Reform

Hello all, I know the best laid planes of mice and men....everytime I think about creating more of my own posts I end up getting caught commenting on other people's posts on other blogs. Well let's try some posts on my actual blog.

New York Times today has a good article on accidental radiation overdoses. The machine at fault is a fascinating contraption. Basically it works like hand puppets on a wall. Metal 'leaves' block the radiation. Software adjusts the control the shape of the radioactive beam so that the only radiation that hits the body is what is needed to hit the tumor. (See this excellent animation/graphic).

The problem in the worst cases seems to be the machine opened all the 'leaves' giving fatal doses of radiation to the patients. In less extreme cases, the beams were the wrong shape or even targeting the wrong areas resulting in needless exposure to patients (thereby increasing the risks of additional cancers later in life) and/or not treating the actual cancer they have as effectively as possible.

This raises two questions for me:

1. Advocates of malpractice reform in place of real health care reform almost always overstate its usefulness. Nonetheless, they ignore malpractices real purpose which is to punish and deter medical errors. There is a huge amount of medical errors (see this book review for a take on how many errors can be cut by using simple and cheap checklists) that happen. What mechanism should be used to confront them? Malpractice is probably the most market orientated mechanism to confront medical error.

2. A more obvious question, why does this machine have a setting that even allows all its 'leaves' to open thereby giving the patient a fatal dose of radiation? I can't delete a file on my computer without a bunch of 'Do you really want to do this' pop-ups. Why wouldn't this machine be designed with a fail safe prohibiting massive, uncontrolled radiation doses?
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