EDITORIALS
Malpractice and Social Change IN THE CURRENT MALPRACTICE situation we are seeing what may be the first of many kinds of such crises in our society. The malpractice crisis of today may be only a forerunner of many others. Crises of this sort may well continue to occur until better methods can be found for people to live and work together in a complex society which is forever undergoing evolution and change, and where whatever is done in one situation can have truly profound and widespread effects throughout a significant segment of the whole. It seems that three very basic realities of modern society have yet to become accommodated to one another. The first of these is our legal system, which enacts laws to solve problems and uses an adversary approach to interpret the laws and to resolve conflicts. At times this adversary approach may result in the issue being turned on legal points which are quite remote from the original problem which needed decision or resolution. For example, the doctrine of res ipsa loquitur may be applied in a malpractice suit in a situation where there was no real connection between what was presumed to be cause and what was presumed to be effect. Yet the doctrine holds that because they happened together or in sequence there must have been a connection. The second basic reality is truth-as this is understood in science and human experience. In medicine, for example, the laws are those of science and human biology, and problems are solved and -disputes are settled by recourse to what is known or can be found out through science and an examination of human experience and behavior as these are known to apply to the problem. Unfortunately this scientific approach has not yet reached the point where it can be used to solve all human problems and resolve all human
disputes. But in any situation the truth always exists and it is what is sought and used by physicians in their practice and in disputes concerning medical science or patient care. A third basic reality is the interdependence which has become a hallmark of today's world. The extent and meaning of this physical, social, economic and political interdependence is not yet fully understood or appreciated. Nor is either the legal system or science yet able to cope with it. Yet it is there and can be ignored only at peril. The professional liability problem, for instance, has developed from a series of precipitating incidents in separate areas of the nation. This came into sharp focus when one insurance company changed a contract for professional liability insurance for a group of physicians in Northern California. This action brought about a chain of events which may lead to a national crisis with as yet unknown implications for the fiscal viability of hospitals, for the availability of physicians' services and for further government intervention into the affairs of both the insurance industry and the practice of medicine. For whatever reasons, medicine now finds itself at an interface where these disparate realities are coming together, and with some force at that. Understandably, things have begun to get a little rough and may become more so. But it seems likely that the role of physicians and of the medical profession is no different in this situation than in any other where patient care is involved. The interest of the patient comes first. Needed care must be available, its quality maintained and enhanced where possible, and any unnecessary costs for this care should be curtailed. These are the goals of the medical profession as it seeks essential reforms in this trying and unprecedented situation. -MSMW THE WESTERN JOURNAL OF MEDICINE
47
Malpractice and Social Change IN THE CURRENT MALPRACTICE situation we are seeing what may be the first of many kinds of such crises in our society. The malpractice crisis of today may be only a forerunner of many others. Crises of this sort may well continue to occur until better methods can be found for people to live and work together in a complex society which is forever undergoing evolution and change, and where whatever is done in one situation can have truly profound and widespread effects throughout a significant segment of the whole. It seems that three very basic realities of modern society have yet to become accommodated to one another. The first of these is our legal system, which enacts laws to solve problems and uses an adversary approach to interpret the laws and to resolve conflicts. At times this adversary approach may result in the issue being turned on legal points which are quite remote from the original problem which needed decision or resolution. For example, the doctrine of res ipsa loquitur may be applied in a malpractice suit in a situation where there was no real connection between what was presumed to be cause and what was presumed to be effect. Yet the doctrine holds that because they happened together or in sequence there must have been a connection. The second basic reality is truth-as this is understood in science and human experience. In medicine, for example, the laws are those of science and human biology, and problems are solved and -disputes are settled by recourse to what is known or can be found out through science and an examination of human experience and behavior as these are known to apply to the problem. Unfortunately this scientific approach has not yet reached the point where it can be used to solve all human problems and resolve all human
disputes. But in any situation the truth always exists and it is what is sought and used by physicians in their practice and in disputes concerning medical science or patient care. A third basic reality is the interdependence which has become a hallmark of today's world. The extent and meaning of this physical, social, economic and political interdependence is not yet fully understood or appreciated. Nor is either the legal system or science yet able to cope with it. Yet it is there and can be ignored only at peril. The professional liability problem, for instance, has developed from a series of precipitating incidents in separate areas of the nation. This came into sharp focus when one insurance company changed a contract for professional liability insurance for a group of physicians in Northern California. This action brought about a chain of events which may lead to a national crisis with as yet unknown implications for the fiscal viability of hospitals, for the availability of physicians' services and for further government intervention into the affairs of both the insurance industry and the practice of medicine. For whatever reasons, medicine now finds itself at an interface where these disparate realities are coming together, and with some force at that. Understandably, things have begun to get a little rough and may become more so. But it seems likely that the role of physicians and of the medical profession is no different in this situation than in any other where patient care is involved. The interest of the patient comes first. Needed care must be available, its quality maintained and enhanced where possible, and any unnecessary costs for this care should be curtailed. These are the goals of the medical profession as it seeks essential reforms in this trying and unprecedented situation. -MSMW THE WESTERN JOURNAL OF MEDICINE
47
