Finding a cure.

As medical-liability costs rise, insurers raise premiums, and observers pile blame all around, one thing is certain: Doctors have a problem. But they're not taking it lying down. From advocating for new legislation to forming risk retention groups to working to stop problems before they occur, doctors are fighting back. "Doctors' Orders," our "Big Picture" feature this month beginning on page 28, describes the many efforts physicians are making to find a medical-liability cure.

Physicians are not new to this fight. In the 1970s, the medical-liability insurance crisis was more about availability than affordability, so doctors formed their own insurance companies, said Roger E Mecum, executive vice president of the Pennsylvania Medical Society.

Today, a lot of physicians are organizing risk retention groups, "because it's not only an availability crisis but also an affordability crisis," Mecum said. "It's hard to determine, though, if the RRGs will be successful, because of the long-tail nature of medical-malpractice claims."

A new initiative is using mediation as an alternative to the court system. Drexel University and the University of Pittsburgh have active programs for their physicians, and the medical society also has a program to educate doctors about mediation, Mecum said. One concern about the process, however, is that it may reduce the severity of awards but increase the frequency. "Lawyers won't take small cases to court, but they could end up in mediation. So the question is will there be more cases with smaller awards, so the total cost is the same," he said. "That is still being studied, although Drexel has shown its program saves money."

Another important effort involves communication between doctors and patients. "Evidence shows that more open communication does reduce litigation," Mecum said. "One reason patients sue is that no one takes responsibility for what happened. Even if it means offering an apology if an apology is in order, then most people don't end up in court."

As with most maladies, early intervention is key. The sooner doctors talk, the better. The sooner mediation happens, the better. "In Pittsburgh, they try to mediate the problem before the patient leaves the hospital," Mecum said.

Sally Whitney is editor. You may reach her at [phone], Ext. 5340, by writing to A.M. Best Co., Ambest Road, Oldwick, NJ 08858, or by e-mail at [e-mail]. The e-mail address for Best's Review is [e-mail].