Dear Doctor

The Illinois medical community has mounted an aggressive and concerted campaign to market tort reform to its constituency. The campaign is anecdotal in nature, and the complainants’ pleas carry two common themes:

1) If you do not give us what we want, we will not treat you.
2) Every patient who walks through our doors is buying a scratch ticket for a pot of gold.

The first is an unveiled threat that flies in the face of the oath that each and every one of you swore to uphold. The second is a grievously offensive assumption about the patients who fund your practices.

You zealously report the dollar amounts of your malpractice insurance premiums in the media, but you don’t volunteer the context of those premiums. Publish your practice’s income statement! Your patient chokes on the gross dollar amount of your insurance expense, but let him put it into perspective by revealing your salary expense, conference expense, and travel and entertainment expense. If our legislature is contemplating a taxpayer-funded pool to subsidize physicians’ malpractice premiums, then your benefactors are entitled to full disclosure.

Your American audience includes 43 million people who cannot afford health insurance and, no, they are not all lazy and stupid. These people do not populate your waiting rooms. They do not live in your neighborhood; they live in mine. Medical malpractice insurance premiums comprise only 0.56% of health care costs in this country, so tort reform will not change the predicament of the uninsured. Nor will it change the incidence of medical malpractice. A bad doctor will still be a bad doctor, but one cog in the check and balance wheel will be removed. A physician’s skills cannot improve via legislation, but his insurability can. Without the arbitrary and contrived safety net of tort reform, if the insurance industry actuarially determines that you are a risk that cannot be adequately measured and underwritten, then you are certainly a risk that cannot be measured and underwritten by a patient.

For those of us fortunate enough to afford the coverage, the term "health insurance" is a misnomer. We are not insuring our good health; we are insuring ourselves against you. We are protecting ourselves from the certain financial extirpation our families will suffer should we darken your doorway uninsured. The insurance pool allows us to take up a collection to pay your fees should a member of our group suffer a misfortune requiring medical services. We, as individuals, cannot support your lifestyle, but collectively we can make the payments. Our insurance policies indemnify us for the financial detriment caused by a covered peril. You are the peril.

The jurors who levy malpractice case judgments are also not lazy and stupid. The legal system serves as a reminder to you that we are your peers, in spite of your efforts to be peerless. Rather than heed the message sent to you by our courts, you choose to arm a powerful and wealthy lobby to gag the messenger.

In accordance with your design, your patients fear and revere you. Yet you shamelessly prey upon your patients’ fear of ill health and death as you persevere for preferential treatment by our legal system. You practice self-serving, costly and time-consuming defensive medicine, cherishing your own well being at the patient’s expense. Rewards carry risks, and when we bestow financial rewards upon you, we do not expect you to make a career of protecting what we already gave you while adding to the stash risk-free. We are also at risk when we deal with the medical community, so don’t ask us to sign a blanket hold-harmless contract in the form of a pre-settlement of future malpractice claims.

By providing the fruits so quickly, and while the laborer is still green, we have created a protectionist class of professional that has too much "stuff" to lose before ever having proven that it has the "right stuff." If architects were as defensive as physicians, all of our buildings would be boxes. If engineers only made the safe play, we would ferry across rivers rather than cross bridges.We have placed you on a pedestal and showed you that we respect you and expect much of you. Do not peer down on us from the rarified air, spit on us and tell us how complicated your job is. Simply climb down and find a vocation that better suits your temperament. According to the Association of American Medical Colleges, nearly 16,000 fresh-faced physicians and surgeons are minted every year, and they are all looking for work as you were at one time. An Illinois practice was not the dream date for most of you. You came here because the job was here. Supply and demand is a beautifully pure economic mechanism, but the medical community has enjoyed an aberrant supply-sided microeconomy for many decades. Assisted by managed care and the judicial system, the pendulum is swinging back to neutral territory.

Is my measured trust in the medical community devastated? Not yet. In fact, I recently entrusted my vasectomy to a Rockford surgeon. Apparently I am not averse to risk. Thankfully, I was not ushered into a cutting room brimming with scalpel-wielding surgeons eager to educate a captive audience on their financial woes. The true professionals are still out there, and their offices are not wallpapered with greed-induced anti-patient propaganda. Yes, there are still doctors who greet their patients with "what can I do for you?" We just have to wade through the whiners to find them.