LAUSR

439 claims can be brought (“statutes of limitations”), and capping the fees that attorneys can receive from such cases. The most effective laws set limits on non-economic damages that injured patients can recover, e.g., compensation for pain and suffering. The variable impact of these changes in the law have stimulated medical associations and health systems to experiment with approaches outside the legal system that might reduce liability risk. Medical associations, such as the American Psychiatric Association, have produced practice guidelines, in part as a means of reducing clinicians’ liability exposure. Practice guidelines attempt to define the parameters within which appropriate clinical care may take place, based on evidence in the relevant medical literature. They are often written so as to provide flexibility to clinicians, typically noting a variety of acceptable approaches to any clinical situation. Conformance to a generally accepted practice guideline will generally constitute a defense to malpractice claims by offering proof that the defendant-physician has complied with a professional standard of care. On the other hand, failure to comply with a practice guideline does not necessarily prove negligence; the physician can challenge the guidelines themselves or otherwise attempt to demonstrate that his/her behavior fell within the parameters of reasonable physician choice. As with many attempts to reduce malpractice claims, it has been difficult to demonstrate that practice guidelines have been effective for this purpose, even when systematic efforts have been made to encourage their use. A second innovative effort to reduce malpractice claims is exemplified by the approach adopted by the University of Michigan Health System. When medical errors result in harm to a patient, the system encourages prompt apology by the physicians involved and an offer of payment that is usually well below what might be awarded by a court. Evaluation of the program demonstrated that it led to a reduction in the number of lawsuits, lower liability costs, and shorter time to resolution of cases. Its success may be based, at least in part, on many injured patients’ desire for an explanation of what went wrong and an apology for mistakes that were made. However, apology laws may have paradoxical effects. One recent study found that they increased the risk of malpractice suits being filed against physicians who do not perform surgery, while having no effect on surgeons’ liability risk. The effect may derive from patients’ greater knowledge that an error was made, which increases motivation to seek compensation. Given the uncertain effectiveness of legal and systemic efforts to reduce the likelihood that a physician will be subject to a claim of malpractice, the best preventive measures may rest in the hands of individual clinicians. That psychiatrists are among the least frequently sued physicians is probably due, at least in part, to the deeper and more empathic relationships they tend to have with patients. Patients who believe that their psychiatrists truly care about their well-being are less likely to sue, even if something goes wrong. In addition to maintaining a caring doctor-patient relationship, other pillars of prevention include seeking consultation when facing a challenging clinical situation and documenting the rationale for treatment decisions in the patient’s record, including explanations of potential management options that were not selected. As a general matter, doing what is best for the patient remains the surest path to reduce risk of malpractice claims.