Your article “Showdown” in the summer issue of Yale Medicine brings out the sorry state of affairs in the medicolegal climate. When I began the practice of ob/gyn after World War II, my malpractice insurance was $25 a year.

Albert W. Diddle, M.D. ’36
Knoxville, Tenn.

The lucid comments about the malpractice situation and its aggravations were apt and helpful in understanding the dilemma. However they failed to mention one of the major causes of premium increases, which is the failure of state medical examiners boards to take steps to reduce the number of compensable medical errors.

For some years the Public Citizen Health Research Group (PCHRG) has closely followed malpractice suits decided in favor of the plaintiff. During the period 1990-2000, 5 percent of the doctors were responsible for the payouts in 54 percent of the suits. In other words, over half the cases of successful litigation were the fault of only 5 percent of the practitioners.

Overall, of the 35,000 doctors who had two or more payouts during that period, only 8 percent of them were disciplined by their state medical examiners board. The PCHRG publishes these figures periodically, and they emphasize that doctors who are repeatedly found to be at fault are responsible for the increasing costs of insurance for the rest of the profession. The conclusion is obvious: state boards should recognize that it is their duty to discipline the repetitive offenders and with more than a tap on the wrist.

Frederick W. Goodrich Jr., M.D., HS ’49
Medford, Ore.

In reporting on the current medical malpractice crisis, author Eli Kintisch characterizes it as a battle between doctors and lawyers. The cliché is catchy, but it is also misleading. Thousands of attorneys in this country, myself included, devote their professional careers to defending health care providers and hospitals in medical malpractice cases and advocating for tort reform measures that limit physician liability. This is not a case of doctor versus lawyer; it is both broader and more refined than that. At best, the generalization oversimplifies the nuances of the debate. At worst, it serves to perpetuate the misguided animosity that, sadly, polarizes the professions and leaves patients stranded somewhere in the middle.

Ken Baum, M.D. ’01, J.D. ’01
New Haven

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