Surgeons' insurance costs soar

I don't make notes for these talks any more than a good guest, before he goes out to dinner, writes out an agenda of what he's going to talk about the dinner table but, like everybody else, I do have things I'm brooding about. For some weeks now, there've been several items lying at the back of my mind and every time I'm about to shift them to the front, somebody fires a gun or drops a bomb and the back of my mind remains as cluttered as ever.

I don't have to tell you what the shocker was this week but, before we come to that, I'd like to do a little brain cleaning. The stored-up items are as various and unconnected as any other bunch of papers stuffed into a cupboard but they all bear on the life and, in spite of the shocker, the main concerns of different sorts of Americans. What, then, is most likely to be on your mind if you're a boy about to go to college? A girl about to have an unwanted baby? A surgeon... a surgeon anywhere in the United States?

Well, the first item I come on sends me at once to the dictionary. Not to the Oxford or Webster, but to a great and greatly unknown work of American scholarship known as a Dictionary of American English and published in four fat volumes by the University of Chicago Press. Maybe I ought to say it's a work of American and Scottish scholarship because when the idea for it sprouted, the University of Chicago, having gathered all the best American lexicographers, decided that their leader ought to be Sir William Craigie, the great man who'd just finished his work as co-editor of the Oxford English Dictionary.

They sent for him and he arrived in Chicago in, as I recall, in the late 1920s to supervise, for the 14 years of its making, this Dictionary of American English on Historical Principles, to give it its full title, namely to follow the English language through its American changes, to list from their first printed entries all English words that had acquired new meanings in this country, to mark with a cross the thousands and thousands of words that originated in this country, as well as those that passed into American from the language of the Indians and then of the immigrants, whether Spanish, French, Dutch, Italian, German or wherever.

Well, what I was looking for was a phrase that had fascinated me within, I'm sure, weeks of my arriving in this country. It was a phrase that bounced around the headlines and sent up howls of curses from the legal profession. It's the phrase 'ambulance chaser'. Evidently it came in in the late 1890s. This is the first entry, a quotation from a congressman, reported in the congressional record, which is Hansard of the Congress: 'In New York City,' this congressman said, 'there is a style of lawyers known to the profession as "ambulance chasers" because they are on hand whenever there's a railway wreck or a street car collision with their offers of professional service.'

Ambulance chasers were richly rewarded, mainly on their own initiative. By 1909, we find a newspaper report in Massachusetts saying, 'The so-called ambulance chasers promote damage suits on the basis of contingent fees which run as high as 50 per cent of damages thought to be recovered.'

I seem to remember that, in some of the city-slicker movies of the early Thirties, there was an ambulance chaser lurking on the fringe of every street accident. Maybe Michael Parkinson, if he's not already in the bush or even if he is, can tell me if I'm right in thinking that Lee Tracy in which rattling movie played a successful shyster lawyer of this breed.

Well, for several decades past, there's been no need for a crafty lawyer to wear out his shoe leather at all hours of the day and night, tracking down some simpleton who has just slipped on a manhole cover or bruised his shin on a passing motorcar. He, the lawyer, can have a handsome office and keep respectable hours and simply invite the patronage of any nervous person who's about to have an operation. Of course, it's right and proper for a patient to have some compensation against a surgeon who has forgetfully left a clamp in your belly and, I suppose, that malpractice suits have been filed by patients for what the law defines as 'ill-treatment or culpable neglect' since bellyaches and their treatment began.

'Physician heal thyself'' is not a sweet-tempered tribute to the medical profession. The Chinese have an ancient proverb which says that you can't be a good surgeon until you, yourself, have been knifed and I remember a man, John Earle, writing in Shakespeare's time, who practically threatened a malpractice suit with the reflection, 'the surgeon's gains are very ill got for he lives by the [hurts] of the commonwealth and he holds a patient longer than our courts hold a cause'.

Well, I suppose surgeons everywhere have always had a stealthy fear of malpractice suits but, until about 30 years ago, I'm told, the risk of being bombarded with them was negligible. The premiums paid by surgeons to insure them against such suits were low and routinely paid. My first awareness that the social situation had changed drastically came, oh I should say two years ago, in San Francisco when I met an attractive, youngish man in, I should say, his early or middle forties, who was introduced to me as Mr So and So, the former Dr So and So. He'd gone into business but until the year before he'd been a surgeon and, I was reliably told, a good one.

Unfortunately for him, he had four children. He had, naturally, to feed and support them but something had happened to the average patient. He or she had become no more fearful of an operation, but more cagey about the possibilities of something going wrong, so it had become common for a patient to consult a lawyer before the operation and then wait and see if everything came out all right.

One surgeon I know in New York will not take on a case of anyone who comes to him for a first diagnosis, then waits a while and consults another surgeon and then comes back to my friend for treatment. He had his fill of such shopping around with a man who arrived with his family and, also, a painful condition. My friend told him that his condition was benign but could be cured by surgery. The man and his family panicked slightly and went off to find a doctor who would not recommend surgery. Fair enough. So the man breathed a sigh of relief until a year later, more symptoms produced more panic and he went back to my friend. By which time, his condition was malignant. He had extensive surgery and then sued my friend on the ground that he was negligent in saying, at the first examination, that the condition was benign.

In a sentence, malpractice suits, in this country, have quadrupled, quintupled and more, in the past decade and, inevitably, the insurance companies want higher and higher annual premiums. This San Francisco surgeon was being asked to pay $30,000 (£15,000) a year as precaution against possible malpractice suits, so he quit and is doing very nicely thank you in the bonanza business of real estate. His children are sassy and well-fed.

Now, I see from an item tucked away in an inside page of the New York Times that the annual premium for surgeons in this state, beginning next year, will be $44,000 (£22,000) – that's before you've started to lance a boil or take in a fee. No wonder, you'll say, medical care is such a grievous burden in the United States. And so it is unless you're very rich or very poor, when you can have the best treatment for nothing.

But lest some people listening make odious comparisons with their own superior system, let us not forget that free treatment under any system is only free to the patient. His next-door neighbour and other citizens are paying for it in taxes, either direct or disguised. Still, anybody thinking of moving to America to practice surgery had better think again.

The second item concerns a woman – any woman – who, up to now, could not only have chosen to have an abortion but could get, under some circumstances, federal or state aid for having it. Congress, however, is now considering a so-called 'human life' bill and it's based on medical opinion given before a Senate committee that human life starts in the moment of conception. This is disputed by other experts but not by the drafters of the bill. It would not only deny all funds to women who want an abortion, but would declare abortion to be an act of murder and so enable the states to prosecute accordingly. In effect, it would strike down the Supreme Court's ruling in 1973 which first legalised abortions in this country.

Against the strong argument that life, however embryonic, is sacred, there was posed this week the argument of Mrs Bellamy, the president of the New York City Council, that the protection of human life should also extend to grown women who now would have to seek out illegal abortions and who, from the record, would put their own lives at risk. There's been a sharp decline in maternal and infant deaths in this state since the Supreme Court made abortions legal.

This issue, pro and con abortion, has divided this country so passionately and so severely that as Senator Dole said the other day, when looking for ways of modifying the human life bill, 'there seems to be absolutely no middle ground'.

The third item must have shaken one million American students more than anything else in the news last week. It reported the decision of the House Education and Labour Committee to help President Reagan cut $12 billion from the education budget by sharply restricting government loans to students to pay for their college education. At present, the government will lend money to students whatever their family incomes. The new law would make loans available only to families whose annual income is less than $25,000.

Just think a moment. Your college-bound son or daughter is truly needy if the family earns only £12,500 and it's not because the United States has an outrageous cost of living – it's about half that of England. In the last UN study of expensive cities, London was the fourth in the world and New York was 27th. It tells something about what Americans think of as a subsistence allowance.

There. We've never come to Israel at all. And that's because there are about a dozen attitudes towards the bombing of Iraqis' reactor, attitudes which are boiling up and which have yet to simmer and harden out into an American policy.

It might be good, even, like President Sadat, to make no comment before the Israeli elections on 30th.

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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