Just an accounting nit. Wouldn't that insurance premium be deductable as a business expense? If so, it's applied pre-tax which effectively reduces its cost by your marginal rate. In other words, a $50K policy would cost $25K to $30K out-of-pocket for someone at a marginal rate of 40% to 50%. True?
You are correct. I was trying to keep it simple (and try to emphasize the hardship of liability insurance) but my example is indeed a distortion of reality. Those premiums still must be
earned and no one ranging from the cleaning lady to a neurosurgeon wants to work more this year and get paid less.
HJD1, you raise an interesting point. Medicine is a mechanistic science and a healing art plus every iteration in between. I've seen breast augmentations that would make Mother Nature jealous. Personally, I don't like anything much bigger than a B but a good friend's fiance really has perfect breasts. Such outcomes exist at the intersection of a masterful eye for detail, pure dominion over anatomy/physiology, and incredible manual dexterity.
A good chunk of neurosurgery is voodoo. We have all kinds of medical practices that satisfied a relatively unqualified standard of care 5 years ago which are nearly defunct today. Male infant circumcision, shaving women before gynecological surgery, shaving the head before neurosurgery . . . all make some sense but best evidence to date says they all provide negligible if any benefit. One of the single best effective protocols for reducing the trauma and expense of labor is the presence of a
doula. Weird stuff like that is all art or just part of the science we do not understand . . . yet.
The standard of care is guiding principle. In my state you must provide significant evidence of violation of the standard of care to file a complaint. Sometimes it's relatively simple. A neurosurgeon in my state was performing suboccipital craniectomy (removing part of the base of the skull) as a migraine headache treatment. I thought the patient was lying but her records were quite detailed. In fact, the records even detailed the physician's decision-making process based on his diagnostic studies. Even as a student I realized this guy was either the worst surgeon in the state or he was doing a whole lot of art and very little science. His license was suspended; likely to be revoked but not before several people received an unapproved and otherwise unwise surgical procedure that will likely produce permanent disability.
It is the failure of the medical profession to cull its own herd that gives people like Edwards the opportunity to eat our lunch. Edwards and the other almost decent trial lawyers make a living off our foibles but the present a challenge that often ushers in needed reforms.
The other aspect of the art of medicine is that no one looks like the textbook description. Every patient is a little different and its the ability to navigate the subtleties that separates the great artists of medicine from the people that jus know the science. There's an art to reading people and convincing them to act in their best interests.
Medicine will never be an exact science. My state's legal structure recognizes its limitations and affords every competent physician significant protection from frivilous lawsuits. Alas, the typical patient has relatively little protection from incompetent physicians other than the broad sword otherwise known as the blood-sucking trial lawyer . . . and in truth that's more revenge than protection.
