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    Medical Errors Report Hits Like 'Nuclear Explosion'.


    While changing the medical liability system to protect those who acknowledge error is a key recommendation, it doesn't mean protecting incompetence. "The bums and the bad apples we want out just as much as everybody else ... so that a patient doesn't end up having the wrong place on the body operated on," says Bristow.

    If nothing else, the IOM report is bound to reopen the debate about how to compensate victims for serious medical error. "I don't think trial lawyers are necessarily the problem, but they're not the solution either," says Larry Gosten, JD, of the Georgetown/Johns Hopkins Program on Law and Public Health. He tells WebMD that good doctors often get sued while bad doctors avoid legal scrutiny, so litigation doesn't necessarily improve quality.

    "Punitive damages might prevent certain harmful behavior, but it also might prevent you from innovating. ... It also might encourage defensive medicine," says Gosten, who isn't optimistic that politicians will get the message that legal reforms to encourage adverse event reporting are necessary.

    Ray Woosley, MD, head of the pharmacology department at Georgetown University Hospital, says that a possible limited liability model already exists with vaccines. "There is a foundation set up, and if you are harmed by a vaccine, you are immediately compensated," Woosley tells WebMD. Woosley is a member of the WebMD board of medical advisors.

    It's somewhat surprising that the medical error report from the IOM, an independent group advising the government on controversial issues, has been greeted with such fanfare, particularly since there have been similar alarms sounded before. Perhaps some of the response results from the strong, nonacademic language used to convey the problem.

    "We did the world of medical care a great service by pointing out that we can change the culture in which we perform services by being much more analytical as to how to be safe," says Bristow. "The Hippocratic Oath says, 'First, do no harm.' That we should be able to do."


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