Approaches for dealing with medical injuries are developing quickly today. Publication of the Institute of Medicine's (IOM's) report, To Err Is Human, in 2000 unleashed a variety of innovative ideas, some of which have already prompted policy changes. But the field of patient safety is in its infancy and policy responses to the problem of medical errors remain in flux, suggesting that significant changes lie ahead in the way we address the challenge of reducing the number of patients injured by medical care.

To help anticipate how these new policies may affect the medical profession and health care industry, it is critical to examine the recent medical malpractice “crisis.” The connections between strategies to reduce medical injury and the medical malpractice system are vital and often overlooked. Developments in the medical liability arena will affect the evolution and eventual shape of methods used to combat error in medicine. Moreover, we believe that medical injury policy can and will significantly affect medical liability policy.

This chapter focuses on the implications of the medical injury/medical malpractice dynamic for physician behavior. It is informed by research on defensive medicine we undertook with support from The Pew Charitable Trusts in 2003 and 2004. This research was motivated in part by the ongoing national crisis in medical liability, which hit Pennsylvania particularly hard from 2001 onward.