Medicine in the good old days

by HOWARD M. BERLIN

5/18/2003

I pondered how doctors used to practice medicine because today many good M.D.s are forced to practice defensively. Extra tests are ordered to cover all the bases, further driving up the cost of care. Much of this can be laid at the feet of an expanding pool of greedy personal-injury lawyers who convince patients to sue.

Often, doctors and their insurers are extorted to settle as the expedient course. Some have either changed to less risky medical specialties or retired early, creating shortages of competent providers in some areas.

Recent work stoppages by physicians in several nearby states were staged to draw attention to the high cost of malpractice insurance and the need for realistic tort reform. Yes, there are some bad doctors out there and they should be dealt with. The surgeon who walked out in the middle of an operation to go the bank; the one who operated on the wrong knee; the one who performed a mastectomy on the wrong breast are all reprehensible. There is no defense for negligent malpractice but their actions unfairly taint the great majority of doctors who, in the words of Hippocrates, pledge "to do no harm."

But far too many self-serving lawyers try to convince gullible clients that every congenital malady or unsuccessful outcome in the course of medical treatment is some doctor's fault and to seek deep pockets. The gist of their shameless promotion is, "Got a hangnail? It's your doctor's fault and we can get you money for it."

I was born deaf and have a congenital abnormality that more than a dozen surgeries couldn't fix. However, there was never any thought of looking for someone to sue.

In looking back on how medicine was practiced, I recall my uncle, a long-time Wilmington osteopathic physician. Dr. Berlin belonged to a now extinct breed. He made house calls, either between his morning and afternoon office hours or in the evening after dinner. Sometimes there was more than one stop in an evening.

Probably because he was a pharmacist before becoming a family physician and general surgeon, he did many of his own laboratory tests in his office basement laboratory. He also had his own X-ray machine and darkroom. He never had an office receptionist or physician's assistant. He didn't schedule more than one patient at a time. When the office phone rang, he answered it. He even filled out all the nuisance insurance forms and typed all his correspondence himself.

That's highly inefficient in today's practice. With today's managed care, it's a safe bet that he could no longer practice his kind of medicine if he were still alive.

He wasn't infallible and he probably made some errors in judgment, albeit minor ones, in his medical career. He was human like the rest of us and didn't have the luxury of 20-20 hindsight that personal-injury lawyers use to second-guess doctors' medical judgments. Shakespeare's Dick the butcher had one idea in "Henry VI" when he exclaimed, "The first thing we do, let's kill all the lawyers."

Like many doctors, my uncle was his own worst patient. He suffered several heart attacks and often ignored wise advice to take things easy. Instead, following a brief recovery period, he was anxious to get back to his office and his patients right up until the last attack that killed him. That was more than 30 years ago and I still miss him.

Howard M. Berlin, of Wilmington, teaches electrical engineering and is a member of The News Journal Community Advisory Board. Send e-mail at w3hb@yahoo.com.