Second Opinion

What's that unfamiliar taste in my mouth, nagging at me day after day?

Sadly, it is bitterness. Bitterness at the time, energy and money that I and the women for whom I provide care are now expending day after day on an issue none of us previously thought much about. That issue is medical liability insurance, also known as malpractice insurance.

It has been my good fortune to practice gynecology and infertility care in downtown Louisville for 27 years. Throughout these years I also have been privileged to teach at the medical school.

This has provided me with the opportunity to recruit medical students into my chosen field and to instruct some of them as residents. Interactions with my many wonderful patients and the young people in training have been tremendously rewarding.

But now each interaction carries a burden of knowledge. Knowledge that each patient will be paying a larger insurance premium and/or a larger co-pay to specifically cover that portion of the increasing cost of medical care which can be attributed to the dramatic rise in liability insurance premiums; knowledge that a much larger portion of my income will be used to pay for liability insurance; and finally, knowledge that perhaps I should not be encouraging anyone to enter the field of obstetrics and gynecology.

So, I ask myself, what has happened to drive us toward this crisis?

Are doctors increasingly negligent in the care of patients? Have patient-doctor communications deteriorated to the point that these consumers of our services don't believe they can trust us to provide our best care for them?

Are lawyers encouraging patients to pursue frivolous cases? Are judges and juries assigning excessive "jackpot" awards to patients?

Has the current economic slump in the United States led insurance providers to protect their financial status by requiring higher premium payments?

As a physician myself, I am loathe to believe that the quality of care provided has changed significantly. However, I do understand that as less and less time is spent with each individual patient, there will be an increasing perception of distraction that inevitably will breed discontent if not outright distrust.

Can solutions be identified and implemented? In the short term, it is difficult for me to be optimistic as medical liability insurance issues are guided by state laws.

Governors and state legislatures are a vital part of any resolution; unfortunately they are already preoccupied with serious financial woes.

Nonetheless, several approaches are under active consideration.

One solution, already utilized in certain areas, is alternative dispute resolution. A board of physicians, lawyers and lay people provide the forum for initial presentation of a case. Although boards may not always be binding, they have served to redress grievances while reducing overall costs in some states.

Coming at the problem from a different angle, Wisconsin has established a physician-supported compensation fund that provides reparation when medical liability insurance coverage has been exceeded.

Another approach has been pressure for tort reform, including such measures as limitation of non-economic damages.

Physician organizations are lobbying state and national representatives for change. One example is the Red Alert campaign being waged by the American College of Obstetricians and Gynecologists.

Charles Hammond, M.D., president of this college, states, "Without liability insurance, OB/GYNs are forced to stop delivering babies, reduce surgical services or close their doors. Women are hurt the most, and now they are joining us in asking the United States Senate to enact meaningful relief."

In this campaign, doctors and their patients are working together to urge change. The "Who Will Deliver My Baby?" portion of this action includes availability of physicians to address questions and refute many of the myths surrounding the debate on reform.

A different tactic brings together groups of physicians who form self-insurance programs or coalitions with other physician groups to obtain greater purchasing power.

Here at the University of Louisville, this is one of the options under consideration. Faculty physicians are exploring the possibility of founding their own company or joining with academic physicians in another state who already have in place a physician-owned corporation.

An integral part of any solution must include a willingness to explore alternatives. Specifically, as a profession, health care providers must continue all efforts to improve quality of care and communication while seeking better ways to address cases of poor medical outcome.

In the end, all interested parties must work to protect the recipients of health care services, while embracing the reality that resources are not unlimited. Money squandered in a dysfunctional system is money lost to provision of care and expansion of knowledge.

Personally, I look forward to the time when I feel able, once again, to actively encourage others to walk with me along the career path that I have found so immensely gratifying

Christine L. Cook, M.D., is a professor of OB/GYN at the University of Louisville School of Medicine. Her comments do not necessarily reflect the official position of the University of Louisville or its administration.