Time Essay: Patients' Rights and the Quality of Medical Care

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It is fitting not merely that he [the physician] should possess a knowledge of diseases and their remedies but also that he should be one who may safely be trusted to apply those remedies. Character is as important a qualification as knowledge. —Supreme Court of the U.S. (1898)

Each year in the U.S. thousands of patients die needlessly, or needlessly soon, or have the quality of their remaining life irreparably damaged because they have received incompetent medical care. In the vast majority of cases, nei ther a suffering survivor nor a next of kin has any recourse. Although malpractice suits now jam the courts, a malpractice award is no remedy; it cannot restore lost health or life or limb.

In this respect, as in many others, medicine stands alone among the professions. Poor performance by a tax accountant, an architect, or a tort lawyer can usually be expressed in terms of dollars, which any layman can understand. Not so with medicine. The cliché has it that medicine is as much art as science. Granted, the art part is in tangible and immeasurable. But much of the science part of medicine remains largely hit or miss. One doctor will pre scribe twice as much of a potent antibiotic as another, or prescribe a needlessly dangerous drug. One surgeon will hurry to operate, while another will say, "This child will outgrow the problem," and spare the knife.

However they may disagree, many doctors are brilliant and dedicated and most are at least competent, practicing in accordance with medical ethics and standards. But the size of the minority who are incompetent, unethical or both is unknown. Too few standards of ethics or practice have been set, and that many doctors will strenuously resist any attempt to strengthen or enforce them became evident last week in an anti-standards revolt within the American Medical Association.

Because surgeons' work is more tangible and precise, surgery was the first area of medicine to come under critical scrutiny. For a half-century, the American College of Surgeons has condemned operations by insufficiently qualified surgeons, fee splitting between surgeons and the physicians who send them patients, and needless surgery. But while the college's professed policies are unimpeachably correct, effectiveness and enforcement are another matter. The college expels few of its errant members and does not publish the names of those expelled. Even after expulsion, a doctor can continue to practice "cut more, make more" surgery until some remote state board lifts his license—if it ever does. In fact, many state boards have not revoked a single license in years. As for character, the states set no precise standards, and Washington unfrocks a doctor convicted of income tax fraud, while Maryland lets him keep his license.

Horror stories like that of California's drug-popping Surgeon John Nork (TIME, Dec. 10), while mercifully rare, are not rare enough. Indeed, there is a broad spectrum of incompetent and unwarranted surgery. One reason for the spate of sterilizing hysterectomies and other dubious operations may be simply that there are too many surgeons. The U.S. has twice as many in proportion to population as Great Britain—and Americans undergo twice as many operations as Britons. Yet, on the average, they die younger.