Physicians Can Heal the Hurt

By C. Gene Wheeler

Christian Medical Society Journal, Winter 1977.

Malpractice rises before the physician as an imminent bar­rier to his life work. The issues of malpractice touch him as a self-employed businessman, as a professional and as a person.

The most visible obstacle a physician faces is the skyrocket­ing cost of insurance. Many doc­tors pay $1000 a month or more for insurance coverage. No mat­ter what risks were incurred in his work, any self-employed businessman would seriously re-evaluate such monthly pre­miums. Perhaps that is why many physicians in California have opted to practice without insurance and they may well be setting a precedent for medical personnel in other states.

As a professional, the physi­cian regards the malpractice issue as a possible threat to pro­viding quality health care in a free market system. Having trained for his specialty, a physi­cian offers his services as he chooses, while patients seek out a doctor according to his repu­tation in the community. Since the patient is free to go any­where he chooses, the free mar­ket system works to the benefit of all.

Intervention by the government to solve the malpractice problem could rob the physi­cian of his free market status, however, and ultimately, control the choice of services for pa­tients as well. From a pro­fessional point of view, the physician sees the malpractice issue as an invitation to the gov­ernment for regulation of fees and for regular re-certification of his practice. 

For the physician as a person, malpractice breaks down the doctor-patient relationship. As long as a doctor can relate to his patient as a person, he will be able to give professional quality care. But when the physician enters treatment with the mind­set that risks lead to the possibil­ity of malpractice suits, he limits his choices and may omit some that could best serve the patient.

No Turning Back

Though the malpractice crisis brings new pressures, there is no turning back to the days when these problems did not complicate the practice of medicine. The course now is not to consider how to preserve the old system but to determine what new alternatives physi­cians can choose. 

First of all, I believe physicians should practice as though they did not have insurance. It may not be long before astronomical fees or inability to procure in­surance will force doctors to practice without it. To do this we must establish rapport with the patient and take other steps to protect him. For instance, I would suggest that a physician put aside $40-$200 a week (de­pending on his practice) into a trust fund for claim settlements. Then the patient with a legiti­mate malpractice complaint could sit down personally with his physician, perhaps with their attorneys, and together they could settle the claim.

Another step physicians can take now is to discuss alterna­tive means of therapy with a pa­tient. In considering a diagnosis and prescription, we should be aware of the patient's desires and expectations and include her in the decision making. Ask her to discuss with you her goals in seeking medical or sur­gical care. After the operation or hospitalization, ask her to evaluate the care given. Was she psychologically prepared for the treatment? How did she feel about the charges? Were they equitable? Exorbitant? 

Finally, I believe every physi­cian should consider giving up any government payments he might be receiving. If we want to remain free practitioners it is my opinion that we should deal with patients directly and not with the government. If the gov­ernment becomes involved in health insurance, let that be a matter between the patient and the bureaucracy.

Malpractice not only threat­ens the physician's livelihood, but it also endangers his life's work. At present, we have the opportunity to act instead of react and tum the crisis into a challenge for even better health care in the future.

C. Gene Wheeler is a surgeon practicing in Dallas, Texas (1977).

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