I can't do it justice just now (working, bahh), but I'll make it a priority to say more, later, about the other side of the issue.

For now, I'll just say that although I'm a future phsyician (knock on wood), I understand that Shakespeare's quote about "first thing we do, let's kill all the lawyers" is a statement of the importance of a vigorous and independent legal profession to the health of a just society. And I think Dr. Rabblerouser here understands that, too.

It may be a clumsy and melodramatic way to make a point, but it's meant to be just that. It's not a serious policy proposal. It's guerrilla theater, meant to incite discussions like this one. It's also an expression of the very same frustration you write about, at the way the issue has NOT been handled prior to its becoming a perverse circus.

Well, okay. But it's sort of my whole point that his proposal does nothing to advance the discussion, but in fact sets it back by making it look like it's a matter of doctors versus lawyers. Which it isn't.

There are certain things you just don't threaten. And "I will have your wife denied medical care" is one of them. It makes him, to me, utterly lacking in credibility and not someone I think is fit to raise any serious issue.

Granted, it's unprofessional, unhelpful, and generally ugly.

But speaking of "lines you don't cross," I'd be happy to see an end to the TV commercials and print advertisements suggesting that every bad outcome from every illness, disease, or procedure is by definition somebody's fault. There is malpractice, and then there are a hundred things that turn out as best as was possible under the circumstances. Sometimes that's far from satisfactory, but if so, it's very seldom due to inappropriate care. Not only does it cheapen law to suggest otherwise, it messes with the way medicine is practiced.

That's what needs to stop, and I suspect that's what Hawk is trying to illustrate -- just how far have (the minority of) bad lawyers gone in screwing with (the majority of) good doctors?

The stereotypical late-night local TV attorney isn't advancing social justice, or providing a valuable watchdog service against the Big Nasty Medical Establishment. He or she is just preying on people's pain and suffering to make a buck.

And it's apparently lucrative enough they don't need to bother to even establish cause! I was rear-ended last November, and uninjured. I got about 25 to 30 letters and flyers from attorneys, just based on the presence of a police report. I was promised that all my back and neck pain (which was weird, since I had none) would earn me recompense, and I wouldn't pay unless I won. Yeah, thanks.

It's yet another symptom of our revenge society, and in that sense, yes, Dr. Hawk is making the worst possible statement. But there are equally ugly tales of Evil Lawyers ruining doctors' lives and wrecking health care for everyone; I'll dig some up when I get home later.

So now the (minority of) bad doctors are going to deny medical care to the (majority of) good lawyers? See, that's not going to help, I don't think.

It's got nothing to do with denying the existence of the problem. Nobody hates obnoxious, rude, unethical, highly conspicuous jerkweed attorneys more than other attorneys. I hate those people, because they make other people expect me to apologize for them. It's unfair.

There are unethical attorneys, just as there are unethical everything-elses. The mere fact that you represent malpractice plaintiffs does not mean that you are to blame for the avalanche of late-night television commercials. That's a stereotype, based on a relatively small number of folks.

I don't need any Ugly Lawyer tales. I am told Ugly Lawyer tales every time I go outside the house and tell anyone I am an attorney. I deal with lawyers all day, and I've seen them be ugly -- usually with the enthusiastic assistance of their non-attorney clients, who are perfectly capable of being mercenary scoundrels all by themselves, and many of whom have been mercenary scoundrels since long before they sought legal counsel.

This is what I'm talking about -- it's not about all doctors versus all lawyers. It's about problem-solving, and the only point I'm trying to make is that this particular doctor doing this particular thing -- threatening the availability of medical care to your spouse as a result of your profession -- is morally reprehensible. The ends don't justify the means, two wrongs don't make a right, and trying to scare people into thinking they won't be able to get a good doctor if they take a meritorious and entirely valid malpractice case is the worst kind of irresponsibility.

I don't want to start a war here, but I could not disagree with you more, ZV. Tens of thousands of deaths and serious injuries are caused ever year by Medical negligence. Those "late night lawyers" DO in fact provide a valuable service: access to the legal system that they otherwise would not have. Malpractice suits are very expensive to bring, and it is frequently the lawyer himself that is putting up tens of thousands of dollars and thousands of hours working on a case. Taking a frivilous malpractice claim is something that no attorney without money to burn would do.

I have sat at both counsel tables (plaintiff and defense) in these cases, and emotions always run high. But it is an effective way of policing doctors. Statistically, roughly 10% of the doctors are responsible for about 75% of malpractice claims because those docs are alcoholics, drug users, or just plain incompetent. The Medical profession needs to do a better job of policing itself and this problem will improve.

In terms of ruing health care or doctors, nine of the top ten highest-paying occupations in this country are physicians (the other is Airplane pilot). So you'll have to excuse the rest of us for not crying too hard that the orthopedic surgeon had to buy the 40 foot boat instead of the 50 footer.

It is a complex problem, but malpractice suits have been around and mainstream for a long time, and the malpractice insurance rates just recently became an issue. For what it is worth, I think managed care and reduced reimbursement is the reasons the doctors are feeling whatever pinch they are feeling. The HMOs and insurance companies and the number one problem.

I can't deny that Dr. Hawk's proposal is foolish and every bit as spiteful and vindictive as you've claimed but, and I think this is really what motivated the proposal, there has to be some significant and proportional barriers to malpractice suits. And the AMA has just not been able to implement the type of tort reform (so-called?) that would erect such barriers. So... I don't know, I suppose I understand and can empathize with the basis for Dr. Hawk's proposal.

I also don't think malpractice litigation is really one of those eternally intractable issues (like, say, abortion) that we probably won't ever get around to reconciling. In fact, I think the will to implement the obvious solution is lacking because both sides are in a position where suitable reform is costlier than protracted court battles and the status quo.

Linda: Okay, I promise, no tales of bad lawyering. But we agree on the substance of your argument, so I got nothing left.

Basset: No worries; it's not a war and discussion is fun. I don't disagree that the messed up HMO and insurance situation is the real problem. Everything else, I have to disagree. A system that shifts penalty bias toward that small proportion of providers actually guilty of malpractice would be far preferable to the "sue, and see if it works out" mentality on such wide display. The salary discussion is NOT going to happen, partly because it's irrelevant. (Also wrong, but mostly irrelevant.)

Nathaniel: Thanks. You said it better than I, and in less time.

For the record, Hawk was essentially shouted down by the rest of the AMA. And for myself, I work in the place you go when you can't go anywhere else, and I'm proud of it. The docs I work with literally do not care if you have insurance, a criminal record, or a pending lawsuit against their mom. If you're sick, you get care. That's what it's all about. Or ought to be, anyhow. The reasons it's not still deserve some examination.

An attorney and politician whose campaign I worked on had what I thought was a pretty good idea, though I don't know how feasible it would be in practice. He suggested that malpractice suits should go before a panel of doctors and lawyers before they see the inside of the courtroom. This panel would filter out all the obviously frivolous cases, and an attorney gets fined for each frivolous case he brings.

This at least sounds better than caps on awards, which don't do much to alleviate the problem. Mostly, I agree with BassetHound: the insurance companies are the root of the problem. (Article about caps: http://www.insurancejournal.com/news/national/2003/06/02/29436.htm)

I'm not sure how far away from the original point we're allowed to take this, so I apologize in advance if this is poor etiquette.

While I think HMOs and insurance companies play a role in the problem, I also think that the law and policy are a bigger part of the problem. Medical liability insurance is not a profitable offering and is highly regulated (even on a relative basis; insures must invest most of the premiums in low-return markets) so rate increases and poor coverage are direct consequences of poor liability policy.

As far as I can tell, MICRA works, caps work and if was not for entrenched financial interest, this would be a policy issue that could be adequately administered to.

I like M-V's idea, which doesn't need to rely on caps (keeping alive the threat of HUGE penalties for if/when they are appropriate), and it directly involves legal and medical professionals in the process.