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Memo from the Editor: Access




Memo From The Editor


Marianne Dekker Mattera

Doctors are passionate about the malpractice crisis, and rightly so. Not only does it affect your wallet, it affects you emotionally. Defending a malpractice claim is traumatic. It deepens the sense of guilt all caring doctors feel if they've somehow injured a patient, and it enrages those who are named unjustly. It's frustrating to listen to plaintiffs' attorneys twist an unpredictable course of events into negligence and demoralizing to settle a suit you know you'd win, simply because fighting it would cost too much.

Tort reform may well be a way to ease both the financial and the emotional pain, so doctors fight passionately for it. And the rallying cry in the battle has become patients' access to medical care: Doctors who can't afford increasingly steep malpractice insurance rates are limiting their practice or closing up shop altogether, leaving patients without needed care. The argument is a valid one, and I've used it myself.

But the argument is also a calculated one, the one most likely to push the hot buttons of those who can act to make things better. Patients who are afraid that there won't be a doctor available when they need one are more likely to press legislators to enact reform. Legislators are patients, too, and they have the added fear that they won't be re-elected if they go against popular sentiment.

And that's the way things get done in our society.

But if you're going to wave the access-to-care banner, you must be prepared to continue to wave it—whatever happens with tort reform.

You must wave it when it comes time to address health care for the millions of Americans who are uninsured or underinsured. You must wave it even if some of the provisions in the best of the legislative proposals—say, you're required to treat a certain number of indigent patients—grate a bit.

Why? Because you're asking others to bite the bullet when it comes to tort reform. Legislators, many of whom are lawyers, certainly don't find it easy to limit contingency fees or curtail the right to recover damages even a little bit. Patients don't find it easy to side with you, knowing that someday an attorney may tell them that they can't bring a suit because there's no economic upside, or that a doctor who really did make an egregious error might not suffer an appropriate economic punishment.

You are right to point to the problems the liability crisis causes in patients' access to care. Access is a critical issue. And it's right to be emotional about it—in all the key areas of the health care debate.


Marianne Mattera. Memo from the Editor: Access. Medical Economics 2003;6:9.

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