My corrrespondent the Industry Veteran was upset to see me teetering on the doctors’ side, while trying vainly to take the middle road, in the malpractice debate that I highlighted here last week. Meanwhile the same issue (the web site that identifies plaintiffs for doctors) has been busying a slew of doctors and a few of their detractors over at MedRants. The Veteran writes to point out the error of my ways!:

I was sorry to see your statement that you "take the doctors’ side" in their battle against the malpractice lawyers. Among those who deserve blame for the shortcomings and inequities in this country’s two-tier healthcare system, organized medicine is at least as blameworthy as hospitals, Big Pharma and insurance companies. Although you back away from this ill-considered partisanship in subsequent sentences, your initial sentiment reveals a reflexive simpatico that you should try to eradicate.In the first place, efforts to assign principal blame for the healthcare system’s problems remind me of the old Chicago scholasticism that sought to place responsibility for the city’s corruption on either the politicians, the police, the gangsters or big business. All the participants have historically sought to dip their beaks in the public’s blood and, in the case of healthcare, the providers have enacted the Tony Soprano role to an extent equalling that of manufacturers and payers. Paul Starr’s Social Transformation of American Medicine and other monographs have described the tactics that organized medicine used to elevate medical practice from a middling, lower-middle class occupation at the start of the 20th century (when the requirement for admission to Harvard’s medical school consisted of the ability to read and write) into the significant holder of gross domestic product that it is today. "In the physicians’ view," according to Starr, "the competitive market represented a threat not only to their incomes, but also to their status and autonomy…and threatened to turn them into mere employees."While increasing a profession’s exposure to tort liability is rarely the sole means of reforming public policy, I believe that in this case malpractice actions do help to advance the process. Dragging physicians into the dock furthers the demystification and dissipates the profession’s unchallenged self-judgment, both of which permit physicians to insert economic bottlenecks into healthcare while making the provider sector a two-caste system. Other positive functions of malpractice activity include making medicine less attractive to the spoiled princes (and, increasingly, princesses) of American society. Certainly I agree with your contention that the necessary process of knocking physicians from their pedestal can be abetted by the increased use of physician extenders (I prefer the term used by labor historians: "de-skilling") and the enforcement of evidence-based logarithms to constrain self-indulgent, self-dealing, cost escalating "autonomy." Despite the nervous handwringing from some of your fellow bloggers, I also want to advance the feminization (more accurately, the "mom-ification") of medicine to deter avaricious ambition from the profession (keep the Jeff Skillings and the Billy Tauzins in business and policitics where they belong) while making it more hospitable to the needs of 9-5, live-and-let-live employees.I think we can proceed through a long, tedious dialogue on this issue, and we’d probably conclude with more agreement than disagreement. I don’t wish to engage in such a colloquoy, and would instead urge a way for you to expunge your reflexive sympathy for physicians. Instead of maintaining the preconscious image of a workaday British physician such as your father, think instead of the two-dollar whores who demand that the pharmaceutical companies entice them to breach fiduciary responsibilities to patients.

UPDATE: (late Weds) The Veteran‘s anti-physician line may be a little extreme for me, but nothing to the extent to which it’s upset the medblogshpere’s favorite surgeon. Go see Bard Parker‘s reply at A Chance to Cut…