American medicine spends more money avoiding malpractice suits than it pays out in them. The doctor in this story won his case and left medicine anyway. Two-thirds of malpractice suits are thrown out before they reach court. Of the ones that do reach court, eight out of ten find for the physician. On paper that is a system working as designed. The verdict was never the point. Jordan Grumet, MD, an internal medicine physician, was home with his kids at eight at night when a process server rang the doorbell. The case was one he barely remembered, a patient he had a glancing role with who died of something nobody was going to stop. It took five years to resolve. Near the end, the lawyer essentially admitted he had never believed Jordan did anything wrong. He was using him as leverage against a nursing home. Jordan won. He also left clinical medicine. That is the part the dismissal statistics hide. The best study he could find put defensive medicine at roughly 55 billion dollars a year against about 40 billion actually paid out in claims. By age 55, he says, somewhere between half and 60 percent of physicians have been sued at least once, and the risk concentrates heavily in emergency medicine and the surgical fields. The dominant cost of malpractice litigation lands outside the courtroom, in what a physician does for the rest of a career to make sure the doorbell never rings again. Grumet's larger argument is that malpractice is one line item in a longer bill. Insurers, pharmaceutical companies, private equity, venture capital, electronic medical record vendors, malpractice attorneys. Every one of them sits between the two parties who actually generate and receive care, and every one of them takes something out on the way through. The line worth saving from the conversation is this one. When a business entity decides that visits run ten minutes instead of fifteen, or that a given test is too expensive to order, that entity is practicing medicine. And in Grumet's framing, business entities don't take the Hippocratic Oath. They carry a fiduciary duty to shareholders instead. We have handed clinical judgment to organizations whose binding legal obligation runs to someone who is not the patient. His conclusion is that there are only two real stakeholders in health care, the people who hold the knowledge and the people who need it, and that everyone else is a third party who has learned to bill for standing in the middle. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. For physicians who have been through a suit: what changed in how you practiced the week after you were served? #MedicalMalpractice #ThePodcastbyKevinMD