What are the costs to patients of society's failure to solve the growing medical malpractice crisis?

We are seeing reduced access to care of our choice.

A 1984 survey found one surgeon in four had stopped doing some operations.

One example: "I quit going to D.C. hospitals some years ago because it would have cost me more in malpractice premiums," says surgeon Ira Brecher of Silver Spring. "In fall 1984 my partner and I paid a $19,000 malpractice premium. Last September we were charged $47,000, and we have only been involved in one malpractice action, which the judge threw out.

"For the first time we had to go to the bank and borrow to pay our premium. We can raise our fees, but not for Medicare patients [where there is a federal freeze], insurors only pay so much, and we can't always collect more even if we charge it. If premiums go up again next fall -- and we hear they will -- I really don't know what I'll do."

Brecher has quit doing some complicated operations, and refers such patients to George Washington University Hospital, where hospitalization alone may cost twice as much as care in a suburban hospital.

*American doctors are currently paying $4 billion in malpractice premiums, the AMA says.

Many swallow some of it in reduced incomes. But in one way or other, we the patients actually pay most of this bill. "Somebody has to pay it," says Dr. Marvin Schneider, president of the Montgomery County Medical Society.

*Doctors are spending a probable $15 billion a year on "defensive medicine." by AMA calculation.

They are ordering additional tests and taking added time not because they think it medically necessary but just in case things go wrong and a lawyer says: "Did you do that test?"

"Any doctor who tells you he doesn't practice defensive medicine is either a fool or a liar," Schneider says. Adding today's involved tests, some costing $1,000 or more, may help an occasional patient. An added test may also lead to false or misleading results and unneeded, even harmful surgery or other treatment.

*Lack of adequate liability insurance has begun hampering medical research.

Dr. Duane Alexander of the National Institutes of Health says the ability to test new drugs and methods related to pregnancy has been limited. Dr. Max Essex of Harvard believes testing of any AIDS vaccine will be slowed unless the government assumes liability for adverse results.

Vaccinations may already be suffering. The cost of liability insurance and expensive lawsuits have driven most drug-makers out of vaccine manufacturing. The one remaining maker of oral polio vaccine, Lederle, just increased its price by 29 percent to help offset increased insurance costs.

*All of these effects may pale compared to a new lack of trust between doctor and patient.

At least a few patients seem to be feeling this. A new Washington mother said: "The other morning my baby had a mild fever -- 101 -- and was somewhat listless, and the doctor said, 'Bring him in.' I wondered whether he'd have done that before the malpractice thing. On the one hand, I want the doctor to do everything he can. But still I wonder. Is he doing too much? I don't know."

Lack of blind trust can be healthy if it makes patients ask more questions about their care. But some may not get the chance. Services in Los Angeles, Chicago, Detroit and now in Maryland offer doctors a computerized search of court records to spot patients who have filed malpractice claims. Many doctors admit that "if a patient appears litigious or over-complaining, I may suggest he get care elsewhere." One speaker at a medical meeting warned fellow physicians against the following possible litigants: "Patients they perceive to have a psychiatric problem, those who seem angry or confrontive, those who present for a second opinion and state up front that they are checking the doctor out, and those who seem to be in need of money, such as public aid and Medicare patients." That could take in quite a few of us.