The former undisputed champion professions; short of being a pro athlete or a star entertainer, medicine and law were the path to money, prestige, and upward mobility. Dentists were premeds who couldn't get into medical school. Lawyers were always plentiful, but where you went to law school was the determining factor as to your rep and earnings.
Today there are many lucrative career paths open to college grads. In the 1970's only one in four premeds metriculated to medical school, today the odds are better than one in two. Your specialty is the key to big bucks. Thus we have too few primary care physicians and too many doctors with mechanical devices that they can insert into patients for fat fees. Emergency Medicine has become more a life style choice. Decent money for 36 hours of work per week and your free time is unencumbered with beepers or pagers. The down side is that ER's are open 24/7 and have become the safety net for all things medical in our chaotic health care system.
My thoughts today concern the relationship between ER docs and lawyers. There are 2 main divisions in law: civil and criminal. ER docs must coexist with both.
We often treat both the victims and the perpetrators of crime. Gang war casualties end up in the local ER. Victims of assault, child abuse, domestic violence, rape, DUI's, and barroom brawls all find their way into the ER. We treat their injuries, try to alleviate their physical and mental anguish. The state, county, city, and federal authorities also must dealt with by the ER doctor. Evidence gathering, physical examination, and verbal accounts all are required by the legal system. Mandatory reporting and privacy requirements must be carefully navigated. We are expected to meet with prosecuting attorneys and to testify in court regardless of our work schedules. I have had good relations with the local district attorney's office for many years. They go out of their way to try and accommodate my night schedule. When called to court, I dress as a professional. My testimony has secured many convictions, including a murder one against a baby killer. I have enjoyed the good will of the DA's as they do the messy job of keeping us all safe for little pay.
Civil lawyers are a very different beast. Our adversarial legal system is terra incognita for MD's. Doctors are trained to arrive at a truth, a correct diagnosis, a useful treatment. We work together as colleagues to cure or at least ameliorate our patients' suffering. Civil litigators are adversaries. They try and discredit the other side. Plaintiffs lawyers, also sometimes refered to as ambulance chasers, are motivated to prove how unskilled, uncaring, and incompetent a treating physician is in the care given to their clients. If they win they get about 1/3 of the malpractice award, plus expenses. If they lose they get nothing. This motivates them to be less than cordial in the way the approach the defendent physician. The malpractice defense attorney is our knight in shining (?) armor. They take our hand and try and lead us through the mine field of a malpractice trial. I would rather have a colonscopy than be deposed by a malpractice attorney.
I now share with you my secret. I am very happily married to an attorney. Many of my closest friends are attorneys and judges. Our legal system has many flaws but it still the best and fairest in the world. Malpractice reform is necessary. Doctors are human and "to err is human". We make mistakes and our patients and their families suffer the consequences. Given that mistakes will happen and that doctors are trying to do their best, I support a no fault, mediation system to deal with malpractice. Patients will be compensated, doctors will be less pressured to practice "defensive medicine", only the lawyers will be unhappy as their fees disappear.
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