Iatrogenesis and Medical Error: The Case for Medical Malpractice Litigation

D iscussions of medical malpractice seem to end up at either of two extremes: the trial lawyer’s view that injured patients deserve compensation, with the treating physician the best source; and the doctor’s view that such suits unfairly penalize judgmental errors while raising the costs of practicing medicine. The parties to this debate make different assumptions about the nature, purpose, and likely impact of malpractice suits; as a result, the issues are muddied rather than clarified. This article suggests that, viewed in light of recent studies of iatrogenic illness in hospital settings, malpractice litigation may help rather than hinder the quality of medical care delivered. latrogenesis, defined as the undesirable side-effects of medical interventions, is not a new phenomenon. The major study undertaken by the Department of Health, Education and Welfare in 1973 noted that a substantial percentage of adverse medical outcomes occur as the result of treatment.’ Others have concluded that many surgical deaths are avoidable.* Two recent studies have added fuel to the smoldering controversy over the nature and extent of such medical mishaps, drawing attention to a range of medical errors and raising again the question of the tort system’s relationship with medical error. The two