From the editor

SECOND OPINION
BY SIDNEY HARRIS

From the witness stand, more evidence on malpractice

Your article on the malpractice crisis [“Showdown,” Summer 2003] prompted me to think about the huge challenges our profession confronts in the face of rising insurance premiums and jury awards against physicians. During 22 years as an expert witness in otolaryngology malpractice cases, I have learned that lawsuits can arise from almost any doctor-patient interaction and that a jury’s determination of guilt or innocence is not always rational.

My first experience on the stand was in 1981 in a lawsuit filed against a physician who had treated a 20-year-old man for earache. Four days later, he came to a large, inner-city ER with stupor and seizures and died while under care. A post-mortem revealed high levels of heroin in his blood and a temporal lobe abscess, probably related to talc deposits in his heroin mixture. But the abscess was near the site of his recent ear infection, and the ENT was sued for alleged failure to diagnose a life-threatening situation.

After testifying on behalf of the physician, I was amazed to learn the case had been settled for an astounding $450,000. I was even more aghast to hear that all the jurors had thought the physician at fault and would have awarded $1.5 million to the plaintiff. The jury foreman told the judge that I had done a fine job but did not sway them.

Over the next 18 years I acted as an expert for the defense in more than 200 cases. During the past four years I have also done a small amount of plaintiff expert review, both to make me a more acceptable witness before the courts and in recognition that there are incidents of gross negligence in otolaryngology. It is true that HMOs and poor reimbursement have frustrated doctors, and it seems that these frustrations have contributed to worsened communication between referrers and specialists and between physicians and patients. The easiest way physicians can avoid lawsuits is to listen to patients and to be honest with them about expectations. The level of distrust patients have in their medical care is at an all-time high, and this is something physicians must address.

I chose to leave my practice of 25 years to two well-trained otolaryngologists who are 10 years and 21 years younger than I am. I have no clear solution that will help them cope with the dilemmas of our malpractice crisis. National health care has been a failure in Canada (patients who can afford the best care come to our country quickly). The huge multispecialty groups that are gobbling up solo practices would appear to insulate them from litigation, but consolidation has not decreased the number of lawsuits.

We must police ourselves and not allow attorneys to do it for us. The small number of physicians who are providing substandard care should be identified by their colleagues and not be allowed simply to relocate to another state to inflict harm on a new community.

I wish the next generation of physicians good luck. It seems that fewer of our graduates, products of the Yale System, are going into clinical practice these days. Our grandchildren will depend on this group for their medical care. Who will remain to upgrade this talent gap?

Donald Kent, M.D. ’72, HS ’76
Palm Harbor, Fla.

From the Editor:

Changing medicine’s cultural landscape

When I was a child in Washington in the early 1960s, I was present for, if not exactly cognizant of, the reaching of several milestones on the road to equal opportunity. One was Martin Luther King’s “I Have a Dream” speech, which I witnessed from the Mall near the Lincoln Memorial with my parents at the age of 3. Another fell under the general heading of school desegregation; my first classroom experience was at a nursery school and kindergarten called Friendship House, which brought together children from varied racial, social and economic backgrounds. Friendship House was a success, and I still have a yellowed Washington Post photograph from the day Lady Bird Johnson came to our classroom for a visit.

Despite this atmosphere of equality, neither of my parents can recall an African-American physician among their acquaintances or on the staff at Children’s Hospital, where my grandmother worked as a receptionist in one of the clinics. In fact, by 1970 only 2 percent of American medical students were members of underrepresented minority groups, compared to 13 percent today. While a significant step forward, that increase is not enough to balance the skewed demographics of American medicine, a situation that has inspired medical schools to try to diversify the physician workforce.

The article that begins on page 16, “An Insider’s View,” by Jennifer Kaylin, describes one of several efforts at Yale to promote diversity in the medical profession. The Summer Medical Education Program, funded by The Robert Wood Johnson Foundation, has graduated more than 765 participants in the past eight years at Yale and increased the number of students of color bound for careers in medicine. The six-week program is organized around the central idea that by exposing applicants to the culture of academic medicine and offering help in the classroom, it can greatly increase their chances of admission to medical school. The undergraduate students who come to New Haven each summer go on rounds, observe in the OR and ER and strengthen their communication and interviewing skills. The program works, says its co-director, at least in part “by fundamentally [altering] their view of the world.”

Our cover story, “Closing the Gender Gap,” tells of another demographic change, this one affecting the traditionally male-dominated discipline of surgery. Since the mid-1970s, Yale has trained an increasing number of female surgeons and now has one of the highest percentages of women on the surgical faculty. Contributing Editor Cathy Shufro explores the factors behind this change and profiles eight women on the Yale faculty, starting on page 26 and continuing on our website, info.med.yale.edu/ymm.

Finally, a parting note that takes us back to Washington, this time to the National Press Club. There, in early November, Associate Editor John Curtis received a top award from the Association of American Medical Colleges (AAMC) for his 2002 article, “Everyone Loves the Yale System. So Why Can’t They All Agree?” It was the second year running that John received an Award of Distinction from the AAMC for his feature writing, and I doubt it will be the last time he distinguishes this magazine or the School of Medicine. If you missed these articles, they, too, may be read on our website by visiting the address above and selecting “Awards.”

Michael Fitzsousa
michael.fitzsousa@yale.edu