Treatment Algorithms to Aid in Tort Reform

By Donald E Bittner, MD

Treatment algorithms is not a new concept, thousands of physicians go through this concept every time they treat patients. The problem is that the physician varies off the algorithm due to fear of the outlying entity that may get them sued for malpractice.

By using treatment algorithms that have been accepted as standard of care by all specialty and sub specialty groups, we could avoid frivolous malpractice suits and save billions of dollars due to unnecessary studies and avoidable procedures. The old cliche, if it sounds like a horse, it most likely is a horse and not a zebra is very true. As an example, the use of MRI's ordered to rule out internal derangement of the knee after physical exam are sometimes not necessary. Ninety nine percent of the time, the complete orthopedic exam will give you enough information to appropriately evaluate the knee before an arthroscopic procedure or to treat the knee conservatively. As we all know, MRI studies are not always exact but most of the time they are ordered to rule out the suspected pathology.

Through an already well established legal concept of Complete Legal Defense, we may be able to use the best treatment algorithms to avoid frivolous lawsuits and save billions spent on unnecessary studies and treatment. Every state has Complete Legal Defense with slight variations. Each state could have accepted panels of specialists or sub specialists that could decide if a malpractice case is worthy of Complete Legal Defense. If so, a panel of legal judges could apply the ruling to the case. Only those cases worthy of such a defense would be eligible for Complete Legal Defense, other cases would follow the same legal process for malpractice cases. Through this pathway I believe many unnecessary lawsuits and a significant amount of unnecessary treatments and procedures could be avoided.


Donald E. Bittner M.D.
dbittner08@fastmail.fm