May 8, 2000 — “I’m not blaming someone for losing the baby. I know bad things happen that are nobody’s fault,” says Linda, a 39-year-old mother of two. “But I am devastated over being told that I can’t have another, and that is somebody’s fault.”
Linda’s baby died during pregnancy, a tragic ending to the anticipation of welcoming a new child. But a year’s worth of complications from a procedure to remove the expired insurance became either unavailable or unaffordable. Today, the pressures on doctors who perform obstetrical care are somewhat different. Decreasing reimbursements from HMOs, added to high malpractice premiums, have raised the cost of providing care so high that many doctors feel they can no longer afford to practice.
“We’re in a crisis situation,” says Susan Wilson, MD, a San Francisco ob-gyn, who recently restricted her practice to gynecology. “HMO reimbursements are so low that they don’t cover the cost of providing care. Sometimes what the nightmares and sleepless nights caused by lawsuits is the worst,” says one retired ob-gyn who wishes to remain anonymous. He left his private practice after 35 years when he realized that he was working three months of the year solely to cover the cost of his $60,000 malpractice insurance premium.
“I’m not paid a penny more for high-risk cases,” says Laurie Green, aSan Francisco ob-gyn. And “because of the cost of doing business and the threat of lawsuits,” she says, “we have a terrible time recruiting new doctors.”
The combined pressures surrounding obstetrical care continue to take their toll. The ACOG survey shows that as a result of the risk of malpractice, 17.1% of ob-gyns have decreased the amount of high-risk obstetric care they give, 8.9% are no longer practicing obstetrics at all, and 6.2% are decreasing the number of deliveries they perform.
Fairness Need Not Apply
The arbitrary nature of medical malpractice litigation, in which an excellent doctor can be destroyed by a lawsuit while an incompetent doctor escapes observation, augments physicians’ frustrations. A paper in January’s Journal of Family Practice observed that the doctor’s bedside manner can be a definitive factor in a patient’s decision to pursue litigation. Those doctors with poor interpersonal skills, even when they made fewer mistakes, were morelikely to get sued than those who were better at communicating with patients. Perceived lack of respect or concern was the most common complaint made by patients of frequently sued obstetricians, reported a Florida study cited in the paper.
In Linda’s case, her medical team’s refusal to accept responsibility played a role in her decision. “I became convinced that a lawsuit was the only acceptable way to send a message that you’re not happy with the situation,” she says. “There was an arrogance on the doctors’ part of not being willing to admit that they had made a mistake.”
While Linda’s anguish is legitimate, unfortunately ob-gyns are responding to the psychological and financial costs of lawsuits by abandoning obstetrical practice and deliveries, according to the ACOG survey. And that’s what concerns Strunk.
“The impact in the ’80s was that we had portions of the country left without ob-gyns,” he says. “I think the current pressures will have the same general impact,” he says. Which may well mean fewer doctors tending high-risk pregnancies and delivering babies.
Jennifer Howze’s work has appeared in TheWall Street Journal Europe, The New York Observer, Self, and Travel and Leisure. She is based in New York City.