They had not found a healthcare professional yet and asked me to see a passenger in the back cabin. Luckily the passenger was merely having a bout of food poisoning. She had some diarrhea and vomiting while onboard the flight and had stomach pain. She appeared stable with good pulses and had abdominal discomfort. She had no history of prior surgeries and had never had her appendix removed. She made it through the flight with some discomfort until the paramedics greeted her at the gate.

This is not an often occurrence for me. However, these things do happen to doctors everyday. Although there are laws that protect us from malpractice, called “Good Samaritan Laws,” whenever I hear that call for help, my initial reaction is to do nothing. Then I feel guilty that I am doing nothing and someone may be dying or in serious medical need.

Everyday doctors are faced with internal struggle about how best to manage patients and their situations. Although we are all capable of being first responders, we do not necessarily have to be first responders. What we should do is always direct people to emergency responders and to places where they can get their definitive care. When there is a patient who needs emergent medical care, but we are not prepared to give it, we must direct them to someone who can.

Non-medical people might not understand how a doctor can sit by and not get engaged in an emergency situation. If this were the case, then we would not need emergency personnel or paramedics. The emergency response system is there for a reason. If I get into an accident, I certainly would not want some random doctor not trained in emergency care to look after me.

For example, the patient who complains of chest pain while in the hospital for some other minor reason will typically get a battery of tests such as an electrocardiogram, cardiac enzymes, electrolytes, pulse oximetry, and a chest x-ray even if he or she does clinically look like he is having a heart attack. If the physician fails to do all these things and the patient does indeed have a heart attack, the physician may be on the hook for that event.

Thus in such a litigious environment, every physician should obtain malpractice insurance. In many specialties, such as obstetrics, these costs can be prohibitively expensive in certain states, driving physicians out of those states. However, some states, such as Texas, have addressed tort reform. Texas has enacted a law several years ago that caps noneconomic damages at $250,000. This sort of policy limits liability for the physician and drives down the cost of malpractice insurance significantly. It is interesting to note that since the law went into effect, the number of physicians applying for medical licenses in Texas has increased every year.

Tort reform and capping of damages obviously has the significant benefit of allowing physicians to practice medicine with limited liability. Thus, it is significantly pro-physician and is cost-effective. However, from the patient’s perspective, putting a number on a possible outcome from malpractice may not be palatable. After all, we live in a society where people can successfully sue others for millions of dollars from other types of accidents.

Thus, malpractice will continue to be an issue at the forefront of the health economic and policy debate. From my perspective, the medical industry is regulated in almost every other area. It might as well regulate malpractice and make the health economy more financially viable.