The Entrance Of Modern Medicine Into 'The Dark Ages'!

---Medicine is “the maintenance of health, the fighting against disease.” Therefore, it would seem senseless to consider any aspect of medical care without first considering and disease process, whichever it may be, which seems to be affecting all other diseases in one way or another.

---Just like I would be foolhhardy to treat a cold in the face of a penumonia, so too would I be similarly foolish, negligent even, if I did not at least discuss a disease process which is acting like an insidious cancer spreading throughout the medical profession and our society.

---...And “medical malpractice” is one such “disease process” which, up till now, has wantonly and negligently been allowed to inflict its damage upon the medical profession and upon the masses of the people...and up till now, gone untreated.

---“Treatment," I believe, comes not in the form of casting accusations, but rather in the form of honest commiunication and greater understanding between people.

---The problem of malpractice, unfortunately, has come to be so out of proportion to its worth and so absurd, that I would be foolish not to think that it is either directly or indirectly affecting the health care of most of us, to both minor and, I personally believe, major degrees...to the point it may very well be affecting the very foundations of the medical thinking throughout the country, foundations upon which diagnosis and treatment of disease--“all” disease--is based.

---Normally, I would not have devoted such an extensive discussion to a given topic, but in this case, the importance of a proper understanding is so great to all of us--I repeat, to “all” of us--that I feel I have had no alternative. Besides, I find very little reading material going to the non-medical person which presents the sincerity behind a doctor’s view.

---Therefore, without any further introduction, I will now present my personal view on the problem...

Is it a complication...or, is it malpractice?
---...Believe it or not, the answer to this question lies at the very root of most of the problems seen nationwide in medicine today, but few people, unfortunately recognize it as such, whether they be lawyers, legislators, or you, ‘the people.’ Some doctors, even, try--although unsuccessfully--to look away. They use some mental mechanism to deny the existence of that which is too painful to face. It’s easier that way, so they think...but inthe long run they cannot ignore what slaps them in the face, for the repercussioins of this all pervasive problem eventually prove, unjustifiably, to be too devastating and to weigh too heavily upon their backs.
---Is it a complication...or, is it malpractice?
---Woe is the society that blinds its eyes to the truth and longer, for this question will have consequences so far reaching that it will come to invade almost every household...and it already has!

---One by one, we, of the medical profession, are being taken down, and we are defenseless against it. It’s no wonder the victors (and they know who they are) cannot hold their heads high with dignity and stand straight and tall.
---After all, it’s no great victory to win out over your opponent when your opponent is not a fighter, but rather, a healer, and when the victor controls and distorts truth and justice and knows how to twist the law to meet his own ends. It’s no wonder in this war (and ‘war’ it is), we, the doctors, and our profession, are slowly, and now not so slowly, being destroyed.
---...But the greatest pity of it all: you, ‘the people,’ are the real victims, the real casualties of this war. And therein lies the reason why it is such a dangerous war, the deadliest and most tragic of all, for it is the kind of war wherein most of you don’t even recognize the incredible extent to which you are directly involved. But you are, you see...most of you are directly involved. For, as long as you ever or have ever or will ever have need of the services of a doctor, you, ‘the people,’ are involved right on up to your shoulders...and beyond!

---Is it a complication...or, is it malpractice?
---Understand the reasoning behind the logical answer to this question and, low and behold, you will have come one step closer to removing yourself from the firing zone, before it’s too late. But time is running out. Remember, your main enemy right now is ignorance, “not knowing” how you’re involved and what it’s all about and how what seems to be numerous other separate medically related problems throughout society, are, in fact, only results of this one more basic underlying problem.

Is it a complication...or, is it malpractice?
---Answer the question and you will have solved the rising costs of medical care to the patient whose average weekly wage cannot oftentimes even pay for a doctor’s visit. Answer the question and you will understand, Do doctors care? and Why is it that they seem only to care about the ‘buck’--their big car, their luxurious home, their bank account? Answer the question and you will find out why you feel like you’ve been ‘had’ after having been whisked in and out of a doctor’s office sometimmes in less than five minutes.

---...Answer the question and you will find out why the doctor is sometimes aloof, why he sometimes doesn’t seem to want to answer your questions, why he sometimes brings you back for more tests, why he operates too much (?), why you fear his judgment and seek out second opinions, why insurance companies ask for second opinions, why some of you think medicine is ‘a ripoff,’ why business entrepreneurs and govermnent seem bent on taking medicine over, and on and on and on...

---...In short, answer the question and you will find out the real reason--the bottom line, the start of it all--behind why you feel angry sometimes, behind why the doctor, believe it or not, sometimes feels frustration, behind why the entire situation has become absurdly and pathetically sad. Yes, answer the question and you will find out where the carinhg and concerned doctor of thirty, forty years ago has gone...Why is he no longer here...or is he?

---To answer the question, let us first travel back in time, into the past by some thirty, forty years, and let us imagine that we have eyes of such keen vision that we can see through the walls of a young child’s bedroom, that of a five year old little boy. And in that bedroom we can see a bed, the little boy lying in it upon his back, his weakened body shaking with chills under the covers, the upper edge of which he is tucking tightly under his chin with the fingers of both his hands. His forehead, throbbing and burning with fever, is just beginning to show beads of perspiration forming, the beads soon to be slowly flowing down both sides of his head.
---For the fourth time this day (those 30, 40 years ago), the fever seems to be breaking. But it will rise again as it has done so again and again the past twenty-four hours. Through tired and heavy eyes he is now gazing in an upward direction and just able to make out the worried expressions on his mother’s and father’s caring faces.
---...There is darkness outside. Nighttime, 10 P.M. in the evening. The subdued light of a dimly lit lamp is emanating softly from under the dark lampshade in the corner of the room, but even that is hurtful to the little boy’s now sensitive eyes. His body aching with a restless pain, he knows he is sick. Yet, through all of this--the curious little fella he is--he is also asking himself, “Why?...Why do I feel this way? It’s not fair...people shouldn’t get sick?”

---Moments later he hears one of his parents saying, in a soft yet excited voice, “Thank goodness...the doctor is here.”
---His head, still aching and throbbing with pain, the little boy soon finds himself looking up at the tired, drawn expression of an old man’s face. The man’s dress: dark suit, ill-fitting with overlong sleeves, his tie still knotted but rolled three, four inches down from his unbuttoned collar. The man is carring a small, black leather bag. The little boy’s parents’ expressions are ‘all wide’ with hopeful eyes, eyes which seem to be saying over and over again, “Thank goodness...the doctor is finally here.”

---Twelve hours was a long time to have been waiting. No matter though; the doctor was now there and the boy’s parents understood that the doctor must have been busy taking cre of other sick patients all day; most probably, the doctor had tried his best to get to the little boy’s house as soon as possible. Besides--and most important--the parents of the little boy trusted the doctor...and they understood him, and they knew that he was a caring person.

---...And even as the doctor plumped himself down upon a chair bedside, the parents could see in the way he took a heavy sigh that he was overworked, probably form being up all the night before with a sick patient, or something to that effect--typical of his dedicted lifestyle. Why, even as a warm smile came to the doctor’s face while he’d begun looking down at the ittle boy’s listless eyes, and even as he said, “Well, how are you young fella?” the boy’s parents could tell by the way he said it that he was trying to be nice even though he was tired--at least, that’s how the little boy interpreted the situation; little kid, sick or not, he was still rather observant...and he tried to smile back...
---...but, five, ten, fifteen minutes later, as the doctor was already getting ready to take his leave, the little boy was looking up from his bed and he could see his parents were smiling; they were shaking the doctor’s hand and thanking him. The doctor had helped them and their little boy, and they were grateful. Why, the uplifted expressions on their faces, that alone, expressed their feelings of sincere appreciation.
---It’s no wonder at that moment the little body directed his attention toward the old man carrying the little black leather bag. It’s no wonder looking up at him and seeing him shaking his parents’ hands--and despite the fact that the old man’s face was parched and lined with the stresses of time and treating the sick--all the little boy could think at that moment was...

---“One day when I grow up I’m going to be a doctor, just like you...I’m going to help people too.”

---And so, with the passage of time, the little boy did grow up, and he did become a doctor...the doctor who writes the very lines you now read, and through these words he is now speaking to you...

---Always I will remember the words of one of my professors in medical school. At the time (when he’s first said them, many years ago), he was standing to the front of the room lecturing to a class of about a hundred medical students. He’d said something to the effect like: “I wish on each and every one of you an illness, but not a very serious illness, not so serious that you will not recover...but serious enough to let you know and ‘feel’ exactly what it’s like to be sick. Maybe then you will know what it means to be a doctor...maybe then you will learn what it means to have compassion.”

---I remember at the time having thought to myself, “You don’t have to tell me that...I’ve already had my share of illness...I know what it feels like.” Besides, at the age of five (when I’d already had my own toy stethoscope), and then again at the age of six and then at seven and eight and again, nine (and on and on), I made myself a promise, repeatedly: I would become a doctor, to stop suffering. I would train myself to become a fighter against one of mankind’s most formidable enemies...I would confront and fight disease.

---Toy or no toy, that stethoscope was no play-toy to me. It was a serious committment, a life-long goal--to help others. At the time, as a little boy, nobody would have believed me, but I remember clearly having thought it to myself, and that’s exactly what being a doctor meant and would always mean and still does mean to me: caring for and helping others.
---...And never once when I’d seen the old man with the little black leather bag (and I’d seen him frequently when I was growing up)...never once had I ever thought the word, ‘money.’ After all, how could I have? My image of a doctor was that of a tired old man, his clothes having always been so oversized and so worn. The image I’d grown up with was a far cry from that, the picture of wealth.

---[Now don’t get me wrong here. I don’t mean to say I’m against money. I like it, probably as much as you. But when it comes to being a doctor, money comes second. The patient’s welfare must always come first.]

---No, no question. It wasn’t money, but rather, ‘appreciation.’ Appreciation was the payment I had grown up with, the only meaningful payment I could really see. Appreciation, from one’s patients...the driving force that would set my life in motion and give my life direction toward something meaningful. Appreciation--if it be but only a warm smile from a grateful patient or a simple ‘thank you’ or a sincere handshake like I’d been so used to seeing--that’s the kind of appreciation that would mold me into the kind of doctor that, as a little boy, I’d always dreamed of being.
---...And when I express all these sentiments, I’m sure I speak for tens of thousands of other doctors nationwide--worldwide--many of whom grew up with and still maintain the very same ideals and similar feelings as me...and all of us, ironically and sadly, today we are now part of a profession that looks to have gone down the path of selfishness, non-caring, carelessness...malpractice...and greed...with all of us so-called ‘non-caring individuals’ subject to being sued regularly!

---Oh my goodness, what in heaven’s name has turned this world so upside down that it takes a profession of caring people and taints it with misdeed?

---Is it a complication...or, is it malpractice?
---Sometimes I, as an adult, ask myself the question: If I, as a child, had known then about the confusion that exists today concerning the answer to that question...if I, as a child, had known then about the terrible wedge of mistrust which, one day, that confusion would create between the caring doctor and the innocent patient...if I, as a child, had known then that one day in the future (after I would finally become a doctor) ‘appreciation’ would begin to wane and rapidly become a long since cherished but soon to be missed sentiment of a bygone era...if I had known all this as that little boy with the toy stethoscope [I have to ask myself now], would I then have chosen the same direction in which to head? Would I have wanted so much to become a doctor?

---It’s a sad state of affairs for any society when it finds many of its doctors even beginning to simply ask themselves that question...and nowadays, they are. I know. I speak to them.

---...But what do all these problems matter to that small idealistic child of thirty, forty years ago? Never in his wildest dreams could he--could I!--ever have imagined a doctor to be any less a person than the image of the old and tired and caring man I had grown so used to seeing. It’s no wonder, even as that small child, I’d begun taking my schooling and studying seriously. As far back as I could remember, I was determined to become a doctor, and I would direct my life accordingly.

---First off, I would learn as much as possible. As a matter of fact, I would make it a practice to try to learn ‘everything’! After all, how difficult could ‘everything’ be? I reasoned like this: there were no more than only a handful of required reading books for each course throughout elementary and high school, whatever the grade, whatever the subject might be. Text or no text, long or short, the amount of information they contained was finite, limited...not of an unending degree. All the information could be mastered if I studied hard all the time, if I worked diligenty. I could do it. I knew I could.
---Besides (and this was most important), one day as a doctor, I would expect no less of myself. To be a doctor, I reasoned, I would have to learn ‘everything.’ After all, as a doctor I would have tremendous responsibility. People would entrust their lives in me...and I would not let them down. I would not want to miss, not even one disease. Yes, no question about it, I would have no choice...I would have to learn ‘everything.’

---And so, ten years old or not, as a child I would embark upon my life-long trek by maintaining a strictness of learning and the discipline required of a doctor, and I would do so immediately. Then, one day, I would be among the greatest of warriors on earth, on the side of fitness, fighting against disease.
---And never would I ever make the mistake to underestimate my opponent; illness can be a frightening thing, but I would muster up the courage and face it squarely. I would arm myself to the hilt. Knowledge would be my sword with which to make a sweeping offense. Determination would be my chariot to forge me ahead; and more learning would lead me to victory!

---Yes, evern as a child I knew that armed with knowledge as I would one day be, I would be the kind of doctor who would never miss in the diagnosis or treatment of disease. I would be a great doctor, and I would make no mistakes. After all, when it comes to people’s health, mistakes cannot be tolerated. Health is simply just too important. In health, we are not working on a car, nor on a typewriter, nor on some other kind of machine. In health we are working on human beings.
---Therefore, it goes without saying, the doctor must have ‘something extra’; he must have some ‘special quality,’ some ‘special ability,’ when it comes to his decisions, to see him through. Yes, the doctor must strive for and maintain ‘a perfectionist’s attitude’!

---Little did I know, as a child, that one day, as an adult, I would eat those words!...and, sadly it sems, so too nowadays is the rest of society also eating those words, for by demanding too much of a doctor’s ability one cannot help but recognize how similar those demands are to the ‘impossible expectations’ of a young child’s idealistic and unrealistic thinking!

---So what! Who cares about placing more demands on doctors!...They deserve it...We’ve been too lenient with them anyway!
---Maybe. Who knows. But I’ll tell you one thing I do know...and that is the psychology of human nature and the way people could react when they feel they are being unjustly accused. And doctors, being people too, are subject to the same psychological reactions as anybody else, just like you.
---Why, naive as I was then (back in high school), becoming a doctor was all too important to me to see anything else but my headstrong ideals and...’studying everything.’ It’s no wonder I graduated from high school as valedictorian, number one in my graduating class, having also been voted ‘boy scholar’ by my classmates. It’s no wonder I also ‘sailed’ through college with such a preponderance of “A’s” that I was accepted to medical school without my having ever graduated from college. and it was easy...I simply studied all the time. After all, I was going to become a doctor!

---If you want ‘no slip-ups,’ ‘no mistakes,’ ‘no errors’...if you want someone who values people’s health to an incredible degree...if you want that ‘perfectionist’s attitude,’ well then...don’t look elsewhere. Simply look at me at the time when I was entering medical school...
---...Nowhere could you have ever found a more naive human being. Why, even then, with all those great marks to back me up, I hadn’t yet learned (just like the little idealistic kid I’d been and just like society seems to be reacting today)...I hadn’t yet learned what medicine was really all about. And how could I have? After all, I hadn’t yet become a doctor let alone gone through medical school.

---To think. How foolish of me...I was ready, back then, to ‘sail’ through my medical training just like I’d done so for high school and college. I was ready to master ‘everything’...but medicine would straighten me out quickly. Within just months of my having first entered those hallowed halls of higher medical learning, I was struck down, hard and fast, by an amazing sense of...helplessness.
---...Suddenly, for the first time, I found myself standing smack dab up against a massive wall, a wall firm, steadfast, and tall. It was a wall of ideas, and of concepts, and of incredibly complex facts that I would need to learn. It was information that I would need to gain. It was the sum total of medical knowledge that mankind had managed to accumulate concerning the workings of the human body in health and disease.
---...Suddenly, I felt very small.

---But that wasn’t the worst of it, for that massive wall of knowledge that I had commited myself to learn, it stood in the mere shadow of an evern greater, a mountainous wall. Why, this second wall was so overpowering and so wide and so tall, the first wall looked to be tiny and insignificant in comparison, like a small bush in the shadow of a mountain!
---...And no wonder, this second wall represented all the vast amount of medical information yet to be discovered and still unknown (for tens of thousands of years to come), information I would need to know if I were to ‘arm myself to the hilt’ as I had planned, if I were to measure up to my self-imposed committment to be a great doctor who would be able to ‘cure all.’ I gulped in awe and shuddered at the time. Why, even David who slew Goliath would have felt pitifully small...and helpless...
---...and I was saddened. I wanted so much to learn ‘everything,’ for the sake of my patients--health was so important--but how could I? How could I learn ‘everything’?...
---...the answer is, I couldn’t, nobody could learn ‘everything,’ not even any of my fellow medical school classmates whose scholastic histories were no less impressive than my own--Phi Beta Kappas, straight “A’s” in college, valedictorians, you name it.

---I found myself seated in a lecture hall. The doctor/professor lecturing to the front of the class had just finished presenting the case history of a patient (from the hospital across the street). The patient had been kind enough (or foolish enough) to subject himself to the probing and examining fingers of learning medical students, the entire examination having taken place to the front of the classroom. The patient having already left the room, the professor was just about to direct a question toward the students, all one hundred or so of them...
---“Can anybody give me the correct diagnosis?...You now have all the information you need.” And indeed we did, so it seemed. The professor/doctor, along with the students who had been called to the front of the room to do the examing, had provided the rest of the class with information in minute detail...such detail as I’d seen in medical books, such detail as I’d already familiarized myself with during those nights of studying. But somehow, although I tried my best to come up with the correct diagnosis, I couldn’t seem to even think of an answer let alone the correct one. Evidently, the information I’d learned from the books hadn’t been enough.
---I looked around the room at the other students. Not one raised hand in sight. “Well!” the doctor/professor called out impatiently [or something to that effect; please note, I’ve taken the liberty here to make up the dialogue to illustrate this example, but the general format and the point it makes is what counts and the way it happened]. “Come on, come on,” the doctor/professor prodded, still impatiently, “if you can’t make the diagnosis, the patient could die.”
---...Obviously the students weren’t taking care of the patient, but the doctor/professor was trying to make a point. Yet, there was still silence in the room. Evidently, everybody else was having the same difficulty as me--they didn’t know.
---“Does anybody know the diagnosis?”
---Then suddenly, everybody seemed to be turning and looking around--one lone hand was raised toward the back of the lecture hall. “Yes?” the doctor/professor said, as if anticipating the student’s immediate reply. Then, rather abruptly (and smugly) the student did speak out, but he called out the name of some disease I’d heard and read about, but a disease so rare I couldn’t possibly imagine how he’d come to the conlusion that that was the correct diagnosis. Curiously, I remember having looked foreward to the front of the lecture hall, and I could see the sudden appearane of a faint smile on the doctor/professor’s face. I think he was shaking his head in an up and down fashion, also with a look of pride and smug satisfaction, as if he was happy that his teaching had at least paid off, if only for one student.
---“Yes!” he then blurted out with a broadened gleam upon his face. “Doctor,” he said, looking toward the student at the back of the lecture hall [and this I do remember], “Doctor...you have just saved a life!” And that was that.

---That one sentence, since that day, I always remembered: “Doctor...you have just saved a life!” Rare disease or not, to the patient who has it, it is very real and very unrare.
---“Doctor...you have just saved a life!”...from that day on, that one sentence--the meaning behind it--that life is precious--would enable me (and I’m sure many other medical students likewise) to tackle the vast amount of medical information throughout medical school and after, no matter how impossible the task.
---...Life is precious. Even if you cannot cure every disease, even if you miss some and make mistakes on others (which would be unavoidable); by saving even one life, it would make it all worthwhile.

---This kind of thinking, I want you to know, is representative of the way we were taught in medical school to think, and I’m sure I’m just one of thousands of doctors everywhere who have always taken and lived by these words seriously,
---...I know I’m right about this.

Malpractice Premiums Going Over $100,000 Per Year...And Guess Who Is Really Paying For It?

---[From reading my medical literature, I find it reported that 25% of the obstetricians in this state alone (Florida), have already ‘quit’ obstetrics and that another 30% are presently consdiering the same. Once again, this is but a mere reflection of what’s happening throughout the entire medical profession, the way doctors are thinking.]

---And if you think you’ve just now (through this writing) realized where the high cost of medical care is coming from (from doctors’ and hospitals’ malpractice premiums), think again; you’re only partially right, and a small part at that. After all, from my understanding and reading of the medical literature, the total malpractice premium costs are presently amounting to only 3 1/2 billion dollars a year nationwide, and I’ve also read it’s estimated to be going to only 7 billion dollars in the next 3 years!

---...Obviously, I’m being sarcastic, in case you haven’t guessed. There are no words to describe the absurdity of the situation but, the truth of the matter is, this ridiculous amount of 3 1/2 billion dollars a year is a mere pittance (it’s nothing!) when compared to the ‘real cause’ behind why medical care costs have increased and behind why your health care could very well be suffering.

---[Now we get down to the ‘real nitty-gritty,’ to some of the real reasons behind how this incredible upheavval in the health care system came abnout in the first place, and what we can do to stop it, maybe...if we’re not already too late...]

---This ‘real cause,’ of course, is only my own opinion, what I believe the ‘real cause’ to be; but, you’ll find, it’s quite logical and I know what I’m talking about. I’ll simply let you make up your own mind after presenting the facts to you; then you will see.
---The fact is, this ‘real cause’ has everything to do with the psychological reactions (of all parties concerned) to the question “Is it a complication...or, is it malpractice?”

---It’s an interesting point, but years ago, complications used to occur. They happened all the time throughout my internship and residency. They had always been considered “an unfortunate side effect” that occurs during the course of disease or during the diagnosis or treatment of disease. A complication was something that “couldn’t be helped,” a ‘bad’ effect that occurred because “medicine”--all of medicine--simply did not know enough or because we could not possibly know ‘everything’!

---As doctors, we had always dreaded complications, and we had always ‘tried’ to take precautions to prevent them, but once they occurred, we had to learn to ‘try’ to handle them...and obviously, we always couldn’t.
---...You see, the plain truth is, complications had always been very common. You couldn’t possibly practice medicine without having them occur simply because so much of medicine is ‘inexact’ and based on ‘percentage judgments’: “I think this” or “I think that” or “this is likely to happen...but, I’m not sure” or “this medication could have this ‘bad’ side effect...but, I’m not sure in this particular patient if it will or if it will not,” hoever, “if I don’t prescribe the medication, then the patient has a ‘good chance’ of becoming worse,” but “I can’t ever say that with 100% certainty”!

---Medicine has always been this way; it didn’t suddenly become this way, and it will probably remain this way for hundreds of years to come. You see, the difference today from 30-40 years ago is that people nowadays are asking more questions either because of ‘mistrust’ or because of ‘a more questioning society,’ and when the doctor, in reply, expresses his ‘uncertainty’--”it could be this,” “it could be that”--the patient often doesn’t like what he hears.
---...Uncertain answers are not very comforting; they don’t make for ‘peace of mind.’ Much of medicine can be frightening. But...these ‘uncertain answers’ run through a sizeable portion of what good medicine is all about.

---It’s an interesting point but, the questioning patient who doesn’t like ‘uncertain answers’ and who feels uncomfortable because of them...he is not much different than the bewildered medical student--confronted by that ‘massive wall’ of endless information and medical uncertainty--who is trying to learn ‘everything.’ Both can feel helpless and frustrated in the face of it [the ‘medical uncertainties’], especially because this ‘uncertainty’ deals with truth.

---Why, the fact is, it took my going through medical school and through years of practicing medicine to learn to deal with that ‘uncertainty’ and to accept it, only to find that medicine nowadays is being torn apart and patients are being victimized and doctors are being sued ‘left and right’ because of it...
---...Such are among the ironies of life!

---Is it a complication...or, is it malpractice?
---...I can tell you this. During my training years ago, a vast amount of what had always been considered to be, and of what had always been taught to me to be, and of what it had alwys only been logical to assume was a complication, was just that: a complication.

---Nowadays, however, many of those same ‘complications’ are commonly being ‘treated’ by ‘some’ people and by our legal system as suspect for ‘malpractice’!

---...To answer the question, allow me once again to reintroduce the implications behind the two terms...
First, both “complications” and “malpractice” are “bad effects,” undesirable occurrences which can come about during the course of practicing medicine.

---“Complication” implies “a bad effect” or “a bad result which couldn’t be helped” or “it’s one of those things that happened even though we did our best.” Obviously, a “complication,” in and of itself, is not the doctor’s fault and he is not to be blamned for it, for something he couldn’t help, especially when the reason he’s there in the first place is to try to help the patient.

---“Malpractice,” on the other hand, can also be a “bad effect,” but it implies “incompetence” on the part of the doctor, that “the doctor should have known better,” that “the doctor displayed, by virtue of the ‘bad effect,’ a disregard for his position as a doctor” and a “disregard for the health and well-being of his patient,” at least that’s what many doctors might think when they hear that word.

---Well, if there is anything that can strike to the core of a doctor (and especially those with genuine feelings for people and a life-long history of dedication toward patients) is to be told that he doesn’t care!...

---...At any rate, I ask you, with medicine so complicated and possibilities of treatment and diagnosis so elusive, where is the ‘cut-off line’ between the two, complications and malpractice?
---...Imagine you’re in high school. You take a test. You get an 80. Well, already you’ve had your ‘bad effect.’ Why didn’t you get 100? Is an 80 malpractice? Did you study but not do your best? Did you, instead of studying, go out to a ball game and in so doing display a total disregard for the taking of that test? Or, did you simply daydream while you were sitting at your desk? Everybody thought you were studying, your little sister, your parents; but only you, when you finally did take that test, only you knew whether you could or could not have done better. Maybe you knew that you tried, that you tried as hard as you could, and maybe you felt bad, and disappointed when you were blamed “for not doing your best” or “goofing off”!
---...What if you wrote a composition and ten different teachers marked it, with grades ranging from 65 to 95? Which is correct? Which teacher’s judgment is best?
---...What if you got a 75 on a test and you were told, “you can do better...I want a 90 on your next test. If not, you’re going to be punished”? What if you try your hardest and only get an 85? Is it your fault? Should you be punished? What if you got a 10 on a test? Maybe then even I would think there is a possibility that you were negligent in studying for the test.
---...How would you feel if every time you got less than a 99 you knew you stood a good chance of being accused that you weren’t doing your best, but in reality you’d always been sincere and trying?

---Well, now you know what’s happening when it comes to ‘complications’ and ‘malpractice.’ The way it stands today, the doctor often has to feel the threat of being blamed if he gets anything short of 100. And when they get an 80, we are leaving the decisions as to whether they ‘did their best’ “in studying” up to people who ordinarily even admit they have little knowledge of, let alone an understanding as to the intricate workings of medicine. But you can best be sure there will always be another doctor around to say “You didn’t do your best,” simply because “the best” to one person is oftentimes not “the best” to another.

---This is especially true of medicine. Unfortunately, you have to be a doctor (unless you have the insight) in order to understand the difficulties in making medical judgments. Contrary to what most people think, medicine is far from an exact science. Maybe some of the procedures are exact, but not when it comes to their interpretation, to the meaning behind, and to the usage of them.

---I believe that a vast majority of doctors feel that the medical profession is being treated unfairly, and I’m not saying that just because I’m a doctor, but because I sincerely believe it’s true and because, speaking as just another person, I value highly what doctors are able to do for us, and I don’t want to see that destroyed. You see, the problem is not just “is it a complication, or is it malpractice?” but also, “what are the doctors’ present or potential reactions to what they consider to be injustice?” What would you do if you felt you could be blamed unjustly every time you even made a move, ironically, to help someone?

---What if you felt that no matter what you did, right or wrong, ‘somebody’ could try to twist the facts around because of their lack of understanding and sue you for untold sums of money and that you would have to spend years trying to defend yourself and possibly lose evrything you ever worked for, indcluding your children’s education? And what if you felt the same thing could happen if you simply were human enough to make an innocent mistake, but were not allowed to? And what if you felt you had to be perfect, and knew you couldn’t, but that if you weren’t perfect, you would ‘suffer the repercussions’? Yes, how would you feel in such a situation when all you really wanted to do was care for your pateint, but now you were frightened every time you made a move?

---...If you ever wondered where the term “defensive medicine” came from, you can stop wondering, but you’d better change its name to that of “self-protection.”

---Doctors want to help you, but the nature of medicine demands that they be left alone in order to do so. When a doctor treats a patient, the only thought within his mind should be about ‘that patient,’ ‘the patient alone,’ and ‘that patient’s problems,’ least of all his being forced to think about his own protection!

---If you doubt that many physicians may well be practicing in fear [when you defend yourself, there is usually a threat from something], well then, I must ask you, why is it that estimates put the costs of “defensive medicine” somewhere in the billions of dollars, some estimates I’ve read being upwards of 15 billion dollars to 1/3 of the entire national care budget. If you think about it, that would be somewhere about 100 billion dollars!
---...That sure seems like an awful lot of ‘protecting’ to me, and incredible! And personally, it’s rather difficult for me to believe such estimates to be true, but whatever they are, I know one thing: this entire situation is wrong...it should not be happening.
---And as much as I read or hear about people saying, “You doctors take it too personally,” they’ll never convince the average doctor who finds himself feeling victimized and unjustly accused.

---You see, it’s all a matter of where you are coming from. If you’re the type of person who didn’t really care in the first place, well then, it’s just the trials and tribulations of the job and you don’t take it too personally. Or maybe you’re the kind of person who lets it simply roll off your back, or the kind of person who orders more tests...
---...But what about the kind of caring doctor who sincerely goes out of his way worrying and worrying about somebody and doing everything he possibly knows to do for that patient to help that patient, nothing more, nothing less, and then that person turns around and blames you...well then, that can be no less than a total disregard for all your life-long intentions, a degrading slap in the face...
---...which brings me once again to my main concern: the doctor’s potential reactions. You see, whether it is a complication or malpractice is no longer as important now as the doctor’s reaction on an individual level and how I think this situation could be changing the entire basis of our medical decisions, and in turn, your health care and treatment, no matter who you are!

---In the way of explanation, I’ll refer back again to medical school, to what one of my doctor/professors said, but just one time during a lecture; ever since, I’ve never forgotten it, and I always have and I always will continue to live by it. He said something to the effect of the following--”...Do the least amount possible on a patient in order to make an adequate diagnosis...and weigh the risks of whatever you do carefully.” He said something to the effect that every time we, as doctors, do something on a patient, always consider the possibilities of harmful effects or complications, whether it be from diagnostic procedures or treatment of diseases...
---...In other words, do as little as you can in the context of what you believe to be good medicine.

---I believe that most doctors understand the significance behind this statement and have always wanted to live by it, but note the phrase in the last sentence: “do as little as you can in the context of what you believe to be good medicine.” Who is to say what anybody believes?
---...That phrase leaves room for variations in diagnosis and treatment a mile long in either direction, with varying decisions to be made by different doctors depedning upon their background, their experience, their judgement, their knowledge. That’s the way medicine has always been--the normal variations within the context of ‘good medicine,’ the difference between this or that doctor, the good one, the not so good, the ‘smarter’ and ‘the not so smart’...the equivalent of the ten teachers marking a composition, grading it from 65 to 95. The “95” could be a simpler ‘test’ with hardly any complications; the “65” could be...who knows, it’s anybody’s guess, even an operation, but ‘all’ within the context of ‘good medicine.’

---The point is, many times there is no ‘one best answer’ for a given doctor, a given patient, a given situation...and only the individual doctor knows whether he ‘tried his best’ when he took the test or treated the patient.

---But the doctor/professor back in medical school probably never anticipated a situation wherein doctors would practice in fear and need protection.
---How far does one go to protect oneself? Each doctor will have to answer this question on his own and I can’t answer for anybody. Some will continue on practicing as if nothing has happened. Others will not allow themselves to be placed in such a position and quit various aspects of the profession where these types of decisions have the potential to come into play. They would rather quit than be in a ‘no win’ situation. Others will retire, simply because the entire situation is ridiculous.

---No wonder 25% of the obsetricians, it’s reported, have already ‘quit’ the practice of obstetrics...and that’s only just the beginning...a sort of barometer for what’s happening throughout medicine.

---But my main concern, as I mentioned, is the potential for what this ‘forced self-protective medical thinking’ might well be doing to the very basis uon which we make our medical judgments. What is it doing throughout the country to the very foundation of all our medical thinking?

---Think of it. Because of the need to ‘protect’ and ‘defend’ oneself, the average standard of medical care might well be in the process of being ‘shifted’ (or have the potential to do so) toward those procedures (and whatever) that enable the doctor to have ‘proof,’ and all this, mind you, within the context of what is considered to be ‘good medicine’ (all within the 65 or 95, or narrower range...either way, there’s till plenty of leeway for variation).

---You see, a doctor might find himself in a situation wherein he can’t ‘prove’ (or at least ‘think’ he can’t prove) what ‘he’ considers to be ‘good medicine,’ or, he might be finding out that other doctors, practicing what he considers to be ‘good medicine,’ are being blamed for what they do regularly. The variations and possibilities in this regard, ‘all’ within the context of ‘good medicine,’ are seemingly endless; and the sad part is, it has the possibility of swaying the thinking, concerning medical decisions, from one ‘norm’ to another ‘norm’ for any given doctor, for any given procedure, both ‘norms,’ mind you, still being within the context of ‘good medicine.’

---And furthermore, that ‘shift,’ although made on an individual level, could occur uniformly, possibly throughout large segments of the population or conceivably throughout the entire country. To make matters worse, because medicine is so complicated, when a ‘shift’ does occur within the context of ‘good medicine’ (say, in the percentage of people receiving such and such a diagnostic test or even operation), the doctors themselves see the increased or decreased percentage, just like you do, but ironically, even they sometimes do not know where that ‘shift’ is coming from--is it based on scientific and medical thinking (which is what is ‘really’ best for the patient, ‘medical medicine’), or, is it based on ‘fear’ and ‘defensive thinking’ (‘legal medicine’)? Conceivably, the ‘shift’ could very well end up in the medical literature as a ‘new norm’!

---For example, what happens if a certain procedure increases in incidence from 10% to 20%? Is that increased 10% due to changes in medical thinking based upon medical studies, or, is that increased 10% based on defensive thinking, or, is that increased 10% a combination of the two? A ‘new norm’ is then established; and, conceivably, 20% can become the ‘new standard’ for practice, one which can be ‘proved’ to be within the context of ‘good medicine,’ and, ironically, as I said, even doctors might be wondering where that new figure came from; but nevertheless, they might have to accept it as their new standard.

---In short, in the climate of defensive thinking, higher or lower percentages for given procedures can conceivably be born out of ‘fear’ and ‘defensive thinking’ and create ‘new averages’ for medical thinking...
---...And guess ho bears the brunt of the bill and guess who receives the ‘new standard’ of care...we ‘all’ do...

---Remember, I am merely giving you an example of what might or could be happening. But it’s surely something to be thinking about. I will tell you this, however. The only way to stop this process is to leave doctors alone to practice medicine solely for the care and well-being of their patients. Remember, that’s all they really wanted to do in the first place. But, in order to do so effectively, there must be no outside influences of any kind to even begin to pressure doctors into any potential change of their medical thinking. There is no other way to ensure good health care.

---And who’s to blame for this entire problem? Well, I know it’s not the doctors’ fault. And, assuredly, it’s not that of the people. The doctors seem to be blaming the lawyers; the lawyers seem to be blaming the doctors, with a ‘uniformity’ of thinking on both sides of the fence, or so it seems. At any rate, that tells me something and sets me to thinking, with the obvious consideration that there are genuine feelings and people on ‘both’ sides of the fence...

---...Sure there are always some greedy lawyers, but there are also always greedy doctors, and greedy butchers and bakers and candlestick makers! That’s just human nature. But when a profession more or less uniformly thinks it is right, whether it be doctors or lawyers, we must all sit down and have a greater understanding, one for the other. There is usually “right’ on both sides of the fence.

---I believe that most lawyers sincerely believe in what they do, and just like doctors, they are needed and very important to all of us. But, I’m not so sure they (just like many people not in the medical profession) understand what ‘medicine’ is really all about and I’m not so sure they udnerstand that behind most angry and frustrated doctors’ faces is a sensitive person who simply wants to take care of his patient.
We’re going to have to have ‘sincere lawmakers’ with the ‘wisdom of the ages’ to solve this problem... and we ‘all’ must help.

---In closing, I’d like to relate back to one more incredible irony. Do you remember the example I referred to, the one about the medical student, the only student in the lecture hall who could make a particular diagnosis when I was back in medical shcool?...the one who was so knowledgeable...the kind of potential doctor who, as a doctor, everybody would want if they had something wrong with their health...the kind of doctor who, nowadays, if he really used ‘his’ best judgment could possibly be making decisions that he couldn’t prove...do you remember him?

---Well, I do. I remember him, and I hope that wherever he is today, he and others like him will not be afraid to use what they consider to be ‘their’ best medical judgment, but if not...if they are afraid..and in the namesake of ‘proof’...
---...imagine...all those years of studying...to treat a piece of paper.