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In Reply: The letters from Drs Kopen, Rude, and Foucar implicitly assume that the tort reforms urged by medical societies and malpractice insurers will resolve physicians' problems with the liability system. We doubt this. Caps on noneconomic damages could lower liability insurance rates (by reducing the value of settlements and judgments), but they would do nothing to diminish the sense of unfairness that many physicians associate with the medical malpractice system. This arises from what many see as that system's propensity to attach moral blame when clinical outcomes disappoint, even when physicians do their best.

Diagnostic and therapeutic uncertainty magnify this sense of unfairness. More often than not, science does not decisively answer the question of which diagnostic or therapeutic approach to take. And in the absence of decisive science, different physicians handle similar clinical scenarios in different ways, resulting in wide variations in medical practice. This leaves physicians vulnerable . . . [Full Text of this Article]

Peter D. Jacobson, JD, MPH
pdj@umich.edu
Department of Health Management & Policy
University of Michigan School of Public Health
Ann Arbor

M. Gregg Bloche, MD, JD
The Brookings Institution
Georgetown University Law Center
Washington, DC

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