"A Dispirited Lot": Malpractice and What Else?
In an unprecedented move that paved the way for the consideration of similar policies in other states, the Massachusetts legislature in the summer of 1996 enacted legislation to give consumers easy access to data on every Massachusetts physician's malpractice awards, disciplinary actions by hospitals or medical boards, lawsuit settlements, and convictions for felonies or serious misdemeanors. To the majority of physicians there, publicizing their mistakes is just one more insult on top of what they perceive as managed care red tape, increasingly onerous insurance company and insurance purchaser scrutiny, and constant second-guessing from all sides. In a reaction typical of the state's medical profession, an internist in private practice for thirty-five years who is also a clinical professor of medicine complained, "We're a dispirited lot" ( Carton, 1996).
Many American physicians in the twilight of the twentieth century are professionally dissatisfied. Although physician comments about, or emanating from, this unhappiness frequently center on attorneys and the awful negative impact of the medical malpractice system on the quality of American medicine for both patients and practitioners, the psychological malaise that runs throughout much of the medical profession today springs from a considerably more complicated combination of sources. The health care system and the role of the physician in it, having undergone a massive but orderly evolution over most of our history ( Cassedy, 1991; Starr, 1982), has been swept up in a virtual revolution over the past decade and a half. This sea change in health care financing and delivery has created a whole slew of perceived ills.