Doctors' strike

There are a couple of things on my mind – and on many more minds than mine – which it would be tempting to unload on you.

One is the report of Vice President Rockefeller on the commission he headed to see if the Central Intelligence Agency had gone beyond the terms of the powers granted to it by Congress, see if it had indulged in domestic as well as foreign spying. As an alarming addition to this report is the work of a Senate investigating committee on the same topic. 

Mr Rockefeller says the CIA has been naughty but not committed any major (that great and useful word)... any major violation of its powers. The Senate committee, on the contrary, says it has in its possession hard evidence not only that the CIA has regularly gone beyond its duties both at home and abroad, but that it has in the past been implicated in plots to liquidate – that is to say in simple English 'assassinate' – foreign political leaders whose views or ideology were presumably not to the liking of the American government. 

This is, needless to say, an horrendous charge and it comes from the chairman of that Senate committee, Senator Frank Church of Idaho, who's one of the most painstaking and least melodramatic senators extant. It's also the stuff of which flaming newspaper headlines are made and I think until we've heard a little more from his committee and Vice President Rockefeller has been persuaded to prove him wrong or to break down into non-committal jargon, I think it would be mischievous at this stage to go into it. 

The other topic, which has recently upset most of California and is now racking New York City, is a strike of doctors and this is by way of protest against the prodigious rise in the premiums that doctors have to pay out to protect themselves against patients' suits for malpractice. It's a growing problem for doctors not only in the United States and it's one that affects countries with different systems of medicine, whether, as in this country, you, you the citizen, pay out insurance money to a private medical benefits society to cover the costs of an illness when it comes or whether, as in most socialist countries, you pay out money in taxes to maintain a free national health system. 

Under any system, the doctors – the surgeons especially – are vulnerable to people who believe, rightly or wrongly, that they've been incompetently treated. It's a far more complicated issue than most doctors, patients, lawyers or even city and state governments care to admit and in New York, at any rate, it's boiling just now in a sea of emotion which had better simmer down before we go into, I hope, a more careful report. 

For the time being though, for people who may wonder why doctors dare to abandon all but the most urgent surgery, I'd like just to mention the... THE cruel fact of life that caused the doctors, first in California and now in New York, to drop their scalpels and retreat fuming to their homes. The internal medicine men, call them the general practitioners, the physicians, are obviously less het up than the surgeons because the human body in its inner workings is infinitely complex and it's almost impossible for a layman, even when he's assisted by a smart cookie of a lawyer, to determine how and where and when malpractice took place. 

If you have a constant bellyache, there are about 40 different ailments you could be suffering from. And a general practitioner is not likely to be vulnerable to a charge of neglect or malpractice unless he gave you nothing but a dose of bicarbonate of soda when the X-rays showed that you had cancer of the colon. So premiums for general practitioners are comparatively low. All the same, in the past year or two, they have trebled or quadrupled. 

Now a surgeon, he's in quite another situation. He cuts you up and no matter how slight or severe the operation, anybody who's had surgery is apt to think that he didn't recover as quickly as he expected to. So he lost more time from work than he'd anticipated, so he will not find it hard if he's sore and determined to get a lawyer who will bring suit asserting that the surgeon had bungled the job. 

To reduce this contrast to its simplest terms, let me tell you about two friends of mine. They're both in their forties, one is a general doctor, a physician. Two years ago, the annual premium he paid as a cushion against malpractice was $350. Let's keep it in pounds and say roughly £150. This year his premium is closer to £400. He grumbles but he can make it. The other friend is a surgeon, also in his forties, who's been wielding the knife for 20 years or so. Five years ago, his malpractice premium was £2,000 a year. Today it is £12,000 a year. That's quite a pile of money to pay out of his net income because you don't get a tax deduction on insurance premiums. 

Well, he's what they call a successful surgeon but he doesn't normally operate on the Shah of Iran. He observes a principle practised by other conscientious surgeons, he charges rich people more than people comfortably off and he keeps the fee as low as possible for the poor. Well, it's not enough for him to grumble; £12,000 a year paid out against the risk of somebody suing him is too much to bear. He has three children, he has a mortgage on his house and he's seriously thinking of giving up the profession and finding some research job where there's no risk of malpractice suits because one of the attractive things about research is that the raw material is not usually a human being but is something in a test tube or under a microscope and it doesn't answer back. Well, that's putting the doctors' case as simply and strongly as I can. 

The New York doctors are, at the moment, arguing with the New York state legislature which put through a bill reducing premium payments but only by a fraction of what the doctors want. So that's when they struck. By the way, we still use the word 'strike' when anybody strikes. The gobbledegook phrase 'industrial action' is still unknown in this country. Well, of course, there's more to it than I've indicated. With fewer and fewer domestically trained doctors and more and more immigrant doctors – many of whom got degrees from medical schools that would simply never be licensed here – there is bungling and incompetence and sloppy care. Out of the whole controversy, we hope that some good will come, some harder and clearer understanding of the best you can expect of medicine in a mixed society and especially in the new condition of our cities. 

And by our cities, I mean 'your' cities, wherever you are, for one of the trends, that 30 years ago nobody foresaw not, certainly any of the learned and astute political leaders who met in San Francisco to organise the United Nations, it is the universal trek of the young from the land to the cities. In 1900, 60 to 65 American families in a hundred lived on farms. Today it's about five. This decline in America could be guessed at with the enormous growth of farm technology. But what we didn't anticipate even 20 years ago was that the same rush to the cities would afflict large, poor countries whose whole economy is dependent on one or two crops. 

I remember once being on a mission for the United Nations in which practically everywhere we went the first problem was easy to see, it was to train the native young. Ah, then the second problem came up. They would be sent abroad in the confident expectation that they would then return home to serve their own people, but they found better-paid jobs in the country they trained in and they stayed. The French had the most ironical experience, as I recall, in Togoland. As their programme of aid to Togo, the French sent there various sorts of specialists in medicine, law, teaching, accountancy and so on, to teach the native young to apply these specialties to their own land. The young who learned well didn't stay. And, at one time, the French were actually receiving from Togo as permanent residents into France more of these native specialists than they were sending in to Togo as instructors. 

In countries whose great need is a modernised agriculture, bright local boys were put through courses to help them transform their own farming. Some stayed. Many, once qualified, went off to practise what they knew in foreign parts. Many simply ditched their new training and went off to the cities where there were no jobs for them. And it must have been, oh, 25 years ago, in the early Fifties at the latest that the mayor of New York gave out a brave and heartening proclamation welcoming depressed Puerto Ricans to come and settle in this city. They were, he rightly remarked, American citizens since Puerto Rico was, if not a state, an American overseas territory. 

I imagine he expected an influx of two, three, four thousand and, at the welcoming ceremony, they were greeted with the words of Emma Lazarus, the scholarly lady who composed the legend engraved on the Statue of Liberty: 'Give me your tired, your poor, your huddled masses yearning to breathe free, the wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me! I lift my lamp beside the golden door!' 

It's a noble sentiment and has moved generations of immigrants from the Jews tossed out of Spain by Ferdinand and Isabella, to the Hungarians and Koreans and now the Vietnamese of our own time. But to very many of the later newcomers, it is a sour and bitter poem. We expected, as I say, four, five thousand Puerto Ricans. So far there have been more than 650,000. Most of them came to New York and had to be squeezed into the stew of Harlem. The tensions between the blacks and the Puerto Ricans are very often at the snapping point. 

The hospitals, owned by the city, cannot possibly accommodate the 'teeming refuse' of the sick and since the city has run out of money, it looks as if those hospitals that don't close down out of bankruptcy will be reduced to serving nothing but emergencies. The time has clearly come for a new general study of the whole hospital system in a city bulging with more people than it can possibly house and care for. 

One grim truth that New York State and the city may come to learn from the gradual but progressive strike of the doctors is that while there are more sick people than the city can handle, the hospital system, itself, is sicker than we knew. 

This transcript was typed from a recording of the original BBC broadcast (© BBC) and not copied from an original script. Because of the risk of mishearing, the BBC cannot vouch for its complete accuracy.

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