Saving the OB/GYN: Part 3

In previous posts, I looked at how the President plays loose with the numbers indicating an OB/GYN shortage and simplistically lays the blame on junk lawsuits.

His misuse of data doesn't mean there's no problem. But let's make sure we're addressing the real issues, and not simply helping the Republicans advance their anti-trial lawyer campaign — which group, I don't need to tell you, provides much of the Democratic party's financial support.

Let's start with the reasons why OB/GYNs have been chosen as poster doctors for Bush's medical liability reform push.

1. OB/GYNs — good and bad — get sued more than almost all other specialties.
2. Does W Stand for Women? Springing to the defense of OB/GYNs makes the Bush Administration look more women-friendly than its policies otherwise could support.
3. Women are more likely than men to have a regular interaction with a physician, and a high proportion of those relationships are with OB/GYNs. Representing the threat with a known and respected specialist makes the case more effectively.

Those so-called frivolous lawsuits should more accurately be called bad outcome lawsuits. They owe more to the realities of human biology and obstetrical practice than to any rapaciousness of trial lawyers. Here are some of the reasons why.

1. Practicing obstetrics can involve split-second decision-making. Lawyers, engineers and writers get to contemplate our work, massage our product and correct our errors. OBs are more like cops. They're called upon to act in life-altering situations, without necessarily knowing all the facts.
2. We have lost any cultural memory of child birth as high-risk to both mother and infant. Patients routinely expect good obstetrical outcomes. How many other interventions by medical professionals are called "blessed events"? It's difficult to accept that a certain number of pregnancies will inevitably result in deaths or serious, long-term complications.
3. Because of this mindset, when bad things happen, people want to assign blame.  It couldn't have been genetics or chance. Someone must've screwed up. Devastated parents, facing financial and emotional costs, are more likely to seek recompense. And juries, seeing kids in wheelchairs or husbands who lost wives, are likely to be sympathetic.
4. More women are delaying having babies. Pregnancies in older women are more likely to have complications.
5. Advances in medical science have allowed lower birth weight infants to survive. They also are more likely to survive with some deficits.

Bad outcomes, not bad OBs or malevolent lawyers, drive court cases. Malpractice insurance premiums, driven by lawsuits and jury awards, are blamed for driving OB/GYNs out of practice. It's true that malpractice premiums are high in some states. But "pure and simple," as the President puts it?

No. But that's for next time.