It doesn't take much to get a rise out of almost any surgeon today. The mere mention of malpractice will send just about any one of them into either a tirade or a funk or both. And given the current state of affairs, it's hard to argue that either reaction is unjustified.

Finding a reasonable middle ground that protects the patient's right to competent medical care and the surgeons' ability to make a living is not going to be easy or quick. The sad by-product of that struggle is the disillusionment that now seems to afflict so many surgeons.

A general surgeon from Indiana recently voiced such disillusionment in a letter to the editor of the American Medical News (April 14). He cited the oft-repeated litany of ills and unfair influences that mark, and mar, medical practice today—the loss of control due to managed care; the astronomical and rising cost of malpractice insurance; the incursion of government into medical decision-making. He's right on every point, and given his status as a general surgeon, who have been especially mauled by malpractice insurance, he's perfectly entitled to rant.

"Regulations stifle us every inch of the way, and the public expects a perfect result in every case, regardless of the problem," he writes. "Practicing medicine feels like walking through a minefield blindfolded. No other profession in our society is held to a higher standard." True on almost every point.

I have to disagree with the expectation of perfection, though. For one, I don't believe it's true. Moreover, making the claim that patients expect perfection risks creating the impression of a persecution complex.

Certainly there are and always will be patients who see an unpredicted outcome as a ticket to Tahiti. The majority of  patients, I suspect, want their surgeon to be well-informed, clear and thorough in the explanation of the benefits and the risks of a procedure, and surgically competent. That's a short sentence that covers a lifetime of continuing hard work to accomplish.
Cutting the Gordian knot that is the current state of malpractice insurance is going to be hard enough without bringing perfection into it.