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Mediation Brings Doctors, Patients Face to Face

April 13, 2000

BOSTON (ANS) — Malpractice lawsuits have been around as long as there have

been doctors and lawyers. But there may be a better way to resolve doctor-patient


It’s mediation, and it’s keeping some potential malpractice suits out of America’s

crowded courtrooms. It’s also providing opportunities for patients to actually talk to

their doctors, and giving doctors a chance to learn something from their mistakes.

In a nonconfrontational atmosphere, the mediator’s role is to sit down with both

sides, as a group and individually, define the issues involved, assist in discussion and

negotiation, and help craft a settlement agreeable to both.

Unlike arbitration, mediation is nonbinding. An arbitrator imposes a settlement:

a mediator simply helps all parties seek common ground.

Barry C. Dorn, an orthopedic surgeon and associate director of the Program for

Health Care Negotiation and Conflict Resolution at the Harvard School of Public

Health, said mediation often gives everyone involved more of a sense of satisfaction. In

a standard malpractice complaint, a doctor would receive a letter from the state medical

board, and “then the board spends a lot of time investigating the complaint,” Dorn said.

Regardless of the board’s final decision on whether the complaint had merit, no one is

left feeling like a winner, he said.

“A letter just goes to the complainant and doctor saying it’s all over — both

parties are left totally unsatisfied,” Dorn said. “If a one-on-one was done with a

mediator, several beneficial results come about: The physician learns something; the

patient hears that the doctor has heard the complaint; and the situation is remedied,

which means more public safety for all patients.”

Mediation is a stark contrast to the litigation route. The most notable difference?

Access to the doctor.

“Usually a doctor hears of a complaint from the state board. He in turn calls his

attorney, who promptly tells him not to talk with anybody,” Dorn said. “The ability to

talk this over one-on-one knocks down the walls between patient and doctor. In over

90 percent of any of the complaint cases, there’s no threat to the common health or any

real malpractice — it’s just an unfortunate accident.”

One New England health maintenance organization — Dorn wouldn’t say which

one — has even developed a pilot project to mediate benefit disputes between its

members and the system.

HMOs see mediation as a way to keep their own costs down, but this kind of

resolution also reaps rewards for consumers. The less HMOs have to spend on legal

fees, the more likely that will translate into affordable rates for subscribers, according to

David T. Caldon, a professor at Pepperdine University in Malibu, Calif.

HMOs aren’t the only health care giant watching the bottom line. The medical

malpractice insurance industry also sees mediation as a way to keep costs down.

“Some (insurance) carriers now encourage physicians to meet with patients after

a complaint,” said Leonard J. Marcus, director of the Harvard program. “Unless it’s a

situation where a physician’s license could be taken away — you couldn’t really remedy

that” through mediation.

There’s another reason for health care consumers to embrace mediation, Caldon

said: It helps to level the playing field. When the cost of litigation outweighs any

possible compensation, patients may not be able to find a lawyer willing to take the


“Ironically, whereas the traditional lawsuit and right to jury trial has long been

seen as the great equalizer the cost of litigating a small claim may keep a person with

only moderate damages out of court entirely,” Caldon wrote in an analysis of the

benefits and drawbacks of alternative dispute mediation.

Dorn and Marcus are trying to get others to sign on to the concept of health care

mediation. Just last week they hosted an international conference for health care

officials in the United States and Canada. One of the conference’s goals was to find out

what states or provinces now work through disputes with mediators — and who would

be open to doing more of it — Marcus said.

As more doctors and patients begin to view resolution as the most effective

strategy, more and more mediators will offer their services in the medical arena. For

now, the concept is so new that those who wish to initiate a mediated complaint should

call the medical oversight board in their home state or contact the Program for Health

Care Negotiation and Conflict Resolution at the Harvard School of Public Health.


This article is copyrighted by The American News Service. Permission is granted to

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Leonard J. Marcus, Program for Health Care Negotiations, Harvard School of Public

Health, Boston, Mass., 617-496-0865.

Dr. Barry C. Dorn, Program for Health Care Negotiations, Harvard School of Public

Health, Boston, Mass., 617-495-4000.


Harvard School of Public Health, Program for Health Care Negotiations, Boston, Mass.,


Health Care Negotiation Associates, Lexington, Mass., 781-861-6116; fax: 781-861-6776;


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