Doctors Turn to Patients as Policy Advocates

With her malpractice insurance costs soaring, Dr. Margaret Lewin is turning to an unusual source for help: her patients. The internist is distributing fliers to everyone who enters her East Side office, detailing her struggle to pay $25,000 a year in premiums in the hopes that they will lobby their legislators for changes to the tort laws. "Imagine how many weeks I must work to simply pay this premium — despite never having been sued!" she writes.

Dr. Lewin is one of many doctors who, frustrated by what they say is a broken health care system, are appealing directly to patients to lobby for change. They are also hoping to protect their relationship with their patients by educating them on the issue of medical malpractice insurance and correcting what they say is a misconception that physicians are making large profits. Among their strategies for outreach are starting letter-writing campaigns, setting up Web sites, and, in the case of one physician advocacy group, airing public service announcements on medical liability in doctors' waiting rooms.

"You're now seeing more of these," a professor at the University of Massachusetts at Amherst's Isenberg School of Management, Eric Berkowitz, author of "Essentials of Health Care Marketing," said. "What I think the medical societies and the physicians have woken up to, like any other industry or business, is if they don't educate their customers, their patients, they're not getting their side of the story out," he said.

Earlier this month, a grassroots group of physicians led by a New York City doctor, Dr. Sean Khozin, penned an "open letter" to patients in which they pledged that they "will no longer remain silent," about a "fragmented" health care system that makes it difficult for patients to receive care.

"The time you spend with your physician has become remarkably brief due to regulatory hurdles requiring doctors to spend more time on documentation than with you," the letter reads. Posted on a physician networking Web site, Sermo.com, the letter has so far attracted more than 1,580 signatures.

In large part, doctors say they are fighting misconceptions about the practice of medicine, including the popular belief that physicians rush through patient exams only to enjoy their own expensive lifestyles.

"They think that we're complaining about nothing," said Dr. Lewin, who said the opposite is true. The cost of her liability insurance is jeopardizing her practice, and she is applying for a license to practice medicine in California, where, she said, malpractice premiums are less.

Doctors said in addition to high liability premiums, they receive insufficient reimbursement from commercial insurance companies. In order to break even, doctors said they must either see more patients or stop accepting insurance.

When a Manhattan gynecologist and obstetrician, Dr. Rebecca Amaru, decided to leave her hospital job and join a private practice, she sent a letter to patients explaining that her caseload had become overwhelming; her hours were long, and she was always running late. "It was a big choice to just opt out of the chaos of it all," she said. She said after reading her letter, "people were so different about it, in the sense that they were very sympathetic."

This summer, when Dr. Amaru and two other physicians in her practice stopped accepting Oxford insurance, they defended their action in another letter that they sent to about 3,000 patients. "We are united in our view that we won't shortchange the hallmarks of our practice by expanding our patient volume, thereby reducing patient visit time and service, as a means to offset reduced reimbursement revenue," the letter said.

One partner at Dr. Amaru's practice, Dr. Isabel Blumberg, said she also wanted patients — some of whom were pregnant at the time — to know that she had their interests in mind.

"It was my way of reaching out to patients, communicating my reasoning, and trying to explain that my office would be there to help them," she said.

Still, some say physicians who communicate their grievances risk alienating their patients.

"Patients might easily feel coerced," an associate professor of clinical psychiatry at Columbia University Medical Center, Dr. Robert Klitzman, said. "Doctors should not vent about how awful the system is for the sake of venting."

Still, if certain changes affect a patient, such as a doctor dropping an insurance company, he said, the patient has a right to know.

In New York, where medical malpractice insurance costs are among the highest nationwide, the Medical Society of the State of New York says patients could soon be affected if physicians leave the state because they can't afford to pay the insurance premiums. In December, the group created a public service announcement describing the problem and encouraged doctors to air the video in their waiting rooms.

In March, the group began circulating a petition among patients that read, "Any further increases in medical liability insurance costs will only add to our health care bills and make it even more difficult to keep our best physicians in practice." The group plans to send the petition to New York lawmakers.

The Medical Society's executive vice president, Rick Abrams, said physicians believe that lawmakers will listen to the public, even if doctors' own voices are not heard. "In the final analysis, regardless of the issue, it is the voters who will change the mind-set of our elected officials," he said. "They need to know from our perspective what the stakes are."