Layperson and physician perceptions of the malpractice system: implications for patient safety

The malpractice tort system functions upon the assumption that the medical profession defines its own standard of care. Hence, clinical assessments should theoretically mirror legal ones. However, if there is a conflict between the two, this conflict may reflect a perceived bias of the system either for or against a party. This exploratory study attempts to determine whether such a bias could exist. Physicians and layperson jury pool members were asked to review 10 jury verdict case scenarios. Respondents were asked first to assess whether the defendant physician provided clinically appropriate care; they were then asked to predict what the jury in the case actually decided. Laypersons showed significantly better agreement with actual jury verdicts on clinical assessment and success in jury verdict prediction than physicians. Both physicians and laypersons switched the favored party from clinical assessment to verdict prediction, with a vast majority of these changes being made from defendant to plaintiff. These results were consistent overall and when parsing assessments by case verdicts. Thus, laypersons and physicians may perceive a similar bias toward plaintiffs in the malpractice system. If these results can be generalized, the malpractice system may be inducing behavior that has a negative impact on patient safety.