WITH HEADLINES proclaiming another medical malpractice crisis, it’s a good idea to take stock of how physicians conduct business with patients.

Let’s face it, in malpractice cases the trouble doesn’t begin with lawyers, it begins with doctors’ interactions with patients. Patients who feel well cared for and have an amicable relationship with their physicians rarely sue, even when there may be a poor outcome to some element of a care plan.

In medical practice for 38 years, I’ve seen the malpractice concerns of physicians rise from minimal to, sometimes, almost hysterical. The scope of our problems accelerated in the early 1970s.

I believe our risks for litigation grew as individuals dispersed away from their core family groups after World War II. The close, long-term contacts with which many of us grew up in our well-defined communities were disrupted. Trust became a victim of that dispersion. People did not have the family ties and, due to frequent moves, did not develop new ones.

That mobile pattern continues to increase today. In addition, the highly publicized scientific developments in medicine began to make the public believe that medicine could cure almost anything and expectations became unrealistic in many cases.

This combination of lost trust in physicians and publicity surrounding miracle cures played a large part in the development of the litigious society in which we live. Of course, this litigious attitude is not limited to physicians, but it hits us hard when we see our insurance premiums rise each year and our coverages reduced.

Cost of doing business

Involved in medical malpractice crisis since the early 1970s with the Nebraska Medical Association committee on malpractice, I later served as a co-author in a group that helped write the Nebraska medical malpractice statute that still exists today.

In the mid-1980s while a professor of family medicine at the University of Cincinnati, I took a sabbatical at the University of Cincinnati College of Law as a scholar in residence to study the basic elements of tort law and how they affect the medical profession. That sojourn led to continued activity in the area of malpractice for the past 16 years.