In the wake of this summer’s medical malpractice crisis, I have seen reference in newspapers and on television linking the problem to “bad doctors.” In support of this, the Government Accounting Office report has been cited (and misinterpreted) which stated about 50% of money paid out for malpractice claims arose from only 4% of Florida’s doctors. This supposedly means that 4% of the state’s doctors are responsible for about half the medical malpractice lawsuits! What this statistic means is simply this: in a period of time, a relatively small number of multimillion dollar judgments against a few physicians comprise about 50% of the money paid out in that period. In any subsequent period, there would again be a small number of doctors hit with large judgments. But the doctors you lost cases each period would not be the same ones. Paul Sharpe, Vice President of St. Paul Insurance Company, has said that his company has not been able to identify a small group of doctors who repeatedly lose malpractice cases. If this were so, they would solve their problem easily by no longer writing insurance for that group of doctors.
Moreover, the above GAO statistics completely ignore the majority of claims filed against Florida’s physicians. Most suits filed do not result in any damages being paid. Yet these litigations exact a heavy toll. Defense attorneys and expert witness must be paid, the physician spends time and energy away from his practice, and he suffers psychological and emotional distress. What editorial writers, reporters, and politicians apparently do not know is that the dedicated physician in a high-risk specialty is the most likely sued. This is the physician whose task it is to treat premature infants who often, in spite of the best care in the world, will be disabled and mentally retarded. This is the physician who treats sick folks who lose a limb, suffer a stroke, die or whether away on a respirator. This is the physician who still responds to emergencies, treating people who have who had been shot, stabbed, or mangled in an automobile accident – who end up paralyzed, brain damaged, or in a vegetative state. This then becomes a fertile ground where malpractice suits are born and grow.
In my seven-year experience as a neurosurgeon at a large urban hospital in Broward County, six malpractice lawsuits have been filed against me. No matter how confident I feel that I am a well-trained, competent physician, these repeated assaults leave my ego battered and scarred. I need to remind myself that all that’s required for doctor to be sued is for him to treat a patient. All the rest can be done by others.
Need I say the foregoing does not imply that all physicians practice good medicine. We have a serious problem of bad doctors and bad medicine. Although I hear pious talk about cracking down on bad doctors, I haven’t heard how this is to be done. Obviously, to achieve this, one must first identify what is a bad medicine and who is practicing bad medicine. I can list three kinds of practitioners I would call bad doctors. The incompetent physician, whether by failure in training, failure to main excellency in an advancing field, or from a character flaw, is a threat to his patient. A quack or charlatan skillfully peddles the latest fad, and not only gouges the unsuspecting patient but also may injure by delaying proper diagnosis. Then there is the practitioner I call the opportunist. His deviation from the standard of care is subtle. His care centers on obtaining a myriad of expensive and sophisticated tests. The patient may be flattered that his physician is sparing no cost to diagnose his illness, not knowing that all are done simply for profit. Now aided by newfangled diagnostic equipment, the possibilities are nearly unlimited. Patients are referred by personal injury lawyers with whom he maintains a symbiotic relationship.
But after having identified the undesirable practitioner, our task has just begun. How do we make him change how he practices medicine, or force him to quit? He will meet you at every step with his attorney. Isn’t it ironic that the same lawyers who professed altruistic motives in suing doctors will now be helping the practitioner who is truly a burden to society? Discipline must come from officially recognized body or panel at the state level. Peer discipline at the local hospital staff level is sporadic, is often motivated by economic and political factors.
Facing medicine today are two problems – malpractice and bad doctors – each exist independently and must be solved separately. To say one problem is caused by the other is not only blatantly false, but also fails to contribute to the solution of either one.
Amos Stoll, MD
Fort Lauderdale