Hupert N, Lawthers A G, Brennan T A, Peterson L M
Division of Medical Ethics, Harvard Medical School, Boston, MA 02115, USA.
Soc Sci Med. 1996 Jul;43(1):1-11. doi: 10.1016/0277-9536(95)00314-2.
Medical mistakes often are responsible for patient injury and suffering, but not all such mistakes are negligent. In the United States, injured patients have recourse to legal action under the common law. The medical malpractice tort trial system is intended to provide compensation for patients who have been negligently injured and to deter future negligent acts by physicians. The deterrent function of torts largely rests on practitioners' capacity and willingness to internalize, or 'process', the lessons of tort trials. However, physicians' willingness or ability to process the tort deterrent signal, while widely assumed in much contemporary legal writing on medical malpractice, has never been empirically verified. This study is a qualitative assessment of how practicing physicians process the tort deterrent signal. We interviewed a random sample of 47 internists, surgeons, and obstetrician/gynecologists from New York State as part of the Harvard Medical Practice Study. The interviews reveal three notable findings: physicians in our sample largely define medical negligence by reference to moral qualities of the practitioner; they claim that lawyers and the legal process of tort trials lack the moral authority to guide medical practice; and finally, while they consequently reject the lessons of lawyer-dominated, confrontational tort trials, they indicate that they would respond more favorably to hospital-based, physician-led, educational quality-control measures. Based on these findings, we identify several potential impediments to the receipt and processing of the tort deterrent signal by individual physicians and we suggest that the interview results support the notion of institutional liability for medical malpractice.
医疗失误常常导致患者受伤和痛苦，但并非所有此类失误都是疏忽所致。在美国，受伤害的患者可依据普通法诉诸法律行动。医疗事故侵权审判制度旨在为因疏忽而受伤的患者提供赔偿，并威慑医生未来的疏忽行为。侵权行为的威慑功能很大程度上取决于从业者内化或“领会”侵权审判教训的能力和意愿。然而，医生领会侵权威慑信号的意愿或能力，尽管在许多当代关于医疗事故的法律著作中被广泛假定，但从未得到实证验证。本研究是对执业医生如何领会侵权威慑信号的定性评估。作为哈佛医疗实践研究的一部分，我们从纽约州随机抽取了47名内科医生、外科医生和妇产科医生进行访谈。访谈揭示了三个显著发现：我们样本中的医生很大程度上通过从业者的道德品质来界定医疗疏忽；他们声称律师和侵权审判的法律程序缺乏指导医疗实践的道德权威；最后，虽然他们因此拒绝律师主导的对抗性侵权审判的教训，但他们表示会对基于医院、由医生主导的教育质量控制措施反应更为积极。基于这些发现，我们确定了个别医生接收和领会侵权威慑信号的几个潜在障碍，并建议访谈结果支持医疗事故机构责任的观点。
