'Lumping it': the hidden denominator of the medical malpractice crisis.

In a recent article, Miller has reminded us that medical malpractice litigation is not simply an economic problem which inhibits medical practice and increases health care costs. She argues that it has three broader "societal objectives": reparation, emotional vindication, and deterrence. Viewed in the broader perspective of social values, the Maine data suggest that our current approach to medical malpractice does not perform well. Significant numbers of respondents believe that they have been neither vindicated nor compensated for their own or their relatives' illness, injury, or death; and that they have not had the opportunity to protect others from harm. As Miller suggests in her review of British alternatives to medical malpractice litigation, there may be more efficient and effective means of reparation. There may also be more direct and less costly means to deter incompetent practitioners and vindicate those who are harmed. We shall never discover these alternatives if we view the medical malpractice "crisis" as a simple or straightforward problem of costs of premiums, costs of settlements, and costs of judgments; numerators. Medical malpractice litigation is the expression of deep and highly complicated problems, which cannot be solved or even significantly alleviated by false solutions motivated only by concerns of costs and cost containment. They can be addressed only by careful, thoughtful, and comprehensive analysis.