I am an emergency physician. I care for about 5,000 patients a year. I have been practicing for 12 years and thus have cared for roughly 60,000 patients.

I receive deep satisfaction from my job and the privilege of the "laying on of hands" as the physician-patient relationship is called in medical school. Most of the time, I rely on the good graces and expertise of the primary care physicians, surgeons and many other specialists to help take care of the people who come to me seeking help. However, recent trends suggest that our hospitals' ability to deliver that care with the help of appropriate specialists is eroding.

A great deal of this quiet but steadily growing crisis is caused by the direct and indirect costs of medical malpractice. The article about the malpractice suit involving Dr. Eric Leefmans ("Man wins $1.75 million suit against area doctor," Sunday Monitor, March 9) demands a response from the medical community.

I take great pride in the hospital where I practice and the physicians I practice with. Many of them worked at or were asked to be academics at major medical institutions. They chose this area because of the quality of life and the quality of medical care delivered here.

Doctor shortage

I would like to send a warning to the residents of New Hampshire: Based on current trends, there will be many fewer of those familiar providers to care for you in 10 years.

Who will be there, for example, to take care of you or a loved one when you have a trauma in the future? In the emergency department, we rely on providers who take calls and come in to take care of patients with medical or surgical illnesses. (Dr. Leefmans was serving that call when he was asked to come in to care for a patient who was ejected from a car on Sept. 15, 2003.) However, there is not an endless list of people, like Dr. Leefmans, waiting to take these rigorous and difficult jobs and suffer the burden of the current medical malpractice environment. There is a long list of people who have removed themselves from call or would like to do so.

In New Hampshire, many physicians are leaving as malpractice insurance costs soar. Specialty physicians have experienced a 50 percent increase in premiums from five years ago. The average premium is now close to $100,000 for obstetricians and neurosurgeons.

Soaring insurance costs

Concord and Manchester have seen a significant decrease in subspecialty coverage in the past five years, including neurosurgical and oral surgery coverage for call. Several small hospitals in the state practice without an anesthesiologist. Only one obstetrician remains to deliver babies in the northern part of the state. Locally, many subspecialty groups have had significant challenges recruiting new physicians to practice in this area. General surgery, one of the most coveted residencies just 10 years ago, now struggles to fill residency positions. Several recent studies and articles predict a significant and increasing gap between the demand and availability of physicians of all types.

Personal responsibility

In cases such as Dr. Leefmans's, where is the discussion of personal responsibility and the societal cost incurred by a patient who seems to have not been wearing a seatbelt and was ejected from a car?

Where is the discussion about the fact that the man's loss of vision most likely arose from the head trauma from being thrown 150 feet rather than the lack of a transfusion as a leading ophthalmologist from Johns Hopkins testified? What about a discussion of who the expert witness was for the plaintiffs? What about the fact that the prosecuting attorney would make between $300,000 and $400,000 on this case and has a perverse financial incentive to prosecute such a case?

Malpractice attorneys say patients need the ability to sue for damages and to be protected from negligence. As in all professions, errors are made; as physicians, we recognize our fallibility and go to great efforts through quality assurance, case reviews and other measures to learn from mistakes and to avoid future errors. However, the extraordinary financial gain lawyers receive from a successful lawsuit decreases their moral authority and credibility on this issue compared to the physicians who spend endless time and effort training for and then caring for their patients. Physicians are there because they love helping and healing patients. When they cannot do that, they give solace. However, the threat of lawsuits and the expectation that everyone will have a perfect outcome, no matter how severe the illness or the trauma, has created an increasingly confrontational relationship between the physician and the patient.

Professional 'experts'

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