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Journal of the Royal Society of Medicine Volume 85 February 1992
Letters to the Editor Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 300 words and should be typed double-spaced.
The medical malpractice crisis I read the article on the malpractice crisis by McQuade (July 1991 JRSM, p 408) with alarm. One in five physician visits in the USA are said to be in the hope of entrapment of the physician in a malpractice suit. The problem arises from the ease with which malpractice actions may be launched, the contingency fee system, the huge sums awarded, the complexity of medical practice in which judgement calls have to be made, and the impossibility of setting standards. Assuming I, a non-physician, deliberately assault or even kill someone, I am unlikely to have financial charges preferred against me by the victim. It is possible, on psychiatric evidence or following statements from my peers that I was otherwise a 'good' person, to receive a suspended sentence. Even if imprisoned, I might be released early for good behaviour. Who has ever heard of malpractice payments being suspended because of good behaviour of a doctor? I would change McQuade's recommendations to: (i) Claims for malpractice and compensation be abolished. (ii) Moneys already collected for this purpose be re-allocated for research purposes. (iii) Retroactive claims to be cancelled. (iv) Competent and capable persons should be encouraged to enter the practice of medicine and law. (v) Competent and conscientious physicians and lawyers be allowed quiet enjoyment of their professions. (vi) Incompetent or impaired physicians and lawyers should be identified and removed from practice, or else rehabilitated and retrained to practice competently. (vii) Complaints against physicians or lawyers be assessed by a body of their peers. (viii) I do not believe that lawyers have any idea of the deleterious effect a malpractice suit has upon a physician. I propose psychological and psychiatric help for physicians against whom suits have been threatened, or brought to court and lost by the patient, funded by a levy on the legal practitioners in that area. F I JACKSON Cross Cancer Institute 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2
Doctors' dress The report by Bishop et al. (September 1991 JRSM, p 522) highlights the patients' expectations of doctors' dress. In recent years there has been a trend for junior doctors to discard the traditional white coat, particularly in the Accident and Emergency Department. Also relegated to the wardrobe are the
shirt, tie and shoes, replaced by open-necked T-shirts and training shoes. The look of surprise on the face of a patient confronted by someone so attired claiming to be 'the doctor' prompted me to perform an informal survey of patients attending the Accident and Emergency department. Of 200 adults questioned, 90% preferred the doctor to 'look like a doctor', ie be wearing relatively formal clothes and a white coat. Most felt more comfortable when attended by a doctor so dressed. It is important that patients can easily identify the attending doctor as such. Let's hear it for the white coat! M WELCH
Department of Vascular Surgery Manchester Royal Infirmary Oxford Road, Manchester M13 9WL
Munchausen 'How do I spell thee? Let me count the ways... The issue ofthe correct spelling of Munchausen is an oft recurring one in the English medical literature. Engel's letter (September 1991 JRSM, p 571) lamenting the loss of the Germanic double aitch and umlaut, represents a common failure to recognize the 'duality' of the famous Baron. Sakula and others1-4 have pointed out that it is necessary to distinguish between the raconteur Baron of historical reality, Karl Friedrich, Freiherr von Miinchhausen of Hanover and the fictional character based on him, created by Rudolf Erich Raspe, the redoubtable Baron Munchausen. The work entitled, Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia, was originally written in English by Raspe in 1785 using the anglicized 'Munchausen' spelling that was perpetuated in the subsequent English editions and later adopted by Richard Asher in describing his now famous syndrome. Inasmuch as the real Baron served only as a model and had no association whatever with the book, the use of the single aitch spelling is the proper one in referring to the imaginary Baron of the English literature and the syndrome which bears his name. The double aitch and umlaut form of Munchhausen should be reserved for the real Baron and the German translations of the Travels. R L GOLDEN
554 Larkfield Road
East Northport, NY 11731, USA References 1 Sakula A. More on Munchausen. Ann Intern Med 1977;87:798 2 Sakula A. Munchausen - fact and fiction. J R Coll Phys 1978;12:286-91 3 Golden RL. More on Munchausen. Ann Intern Med 1977;87:798 4 Golden RL. Spelling of Munchausen: An 'H' of a Mess. JAMA 1983;250:1975
NB: In association with the JAMA letter4 the following editor's note appeared: 'In the future, THE JOURNAL will use the English spelling, Munchausen when referring to the syndrome. - Ed.'
Scalp injury and skull fracture Although the conclusion in Mr Baneijee's interesting article on the unreliability of scalp injuries for predicting skull fractures (August 1991 JRSM, p 502) was clear, his message remained obscure.
Journal of the Royal Society of Medicine Volume 85 February 1992
Letters to the Editor Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 300 words and should be typed double-spaced.
The medical malpractice crisis I read the article on the malpractice crisis by McQuade (July 1991 JRSM, p 408) with alarm. One in five physician visits in the USA are said to be in the hope of entrapment of the physician in a malpractice suit. The problem arises from the ease with which malpractice actions may be launched, the contingency fee system, the huge sums awarded, the complexity of medical practice in which judgement calls have to be made, and the impossibility of setting standards. Assuming I, a non-physician, deliberately assault or even kill someone, I am unlikely to have financial charges preferred against me by the victim. It is possible, on psychiatric evidence or following statements from my peers that I was otherwise a 'good' person, to receive a suspended sentence. Even if imprisoned, I might be released early for good behaviour. Who has ever heard of malpractice payments being suspended because of good behaviour of a doctor? I would change McQuade's recommendations to: (i) Claims for malpractice and compensation be abolished. (ii) Moneys already collected for this purpose be re-allocated for research purposes. (iii) Retroactive claims to be cancelled. (iv) Competent and capable persons should be encouraged to enter the practice of medicine and law. (v) Competent and conscientious physicians and lawyers be allowed quiet enjoyment of their professions. (vi) Incompetent or impaired physicians and lawyers should be identified and removed from practice, or else rehabilitated and retrained to practice competently. (vii) Complaints against physicians or lawyers be assessed by a body of their peers. (viii) I do not believe that lawyers have any idea of the deleterious effect a malpractice suit has upon a physician. I propose psychological and psychiatric help for physicians against whom suits have been threatened, or brought to court and lost by the patient, funded by a levy on the legal practitioners in that area. F I JACKSON Cross Cancer Institute 11560 University Ave, Edmonton, Alberta, Canada T6G 1Z2
Doctors' dress The report by Bishop et al. (September 1991 JRSM, p 522) highlights the patients' expectations of doctors' dress. In recent years there has been a trend for junior doctors to discard the traditional white coat, particularly in the Accident and Emergency Department. Also relegated to the wardrobe are the
shirt, tie and shoes, replaced by open-necked T-shirts and training shoes. The look of surprise on the face of a patient confronted by someone so attired claiming to be 'the doctor' prompted me to perform an informal survey of patients attending the Accident and Emergency department. Of 200 adults questioned, 90% preferred the doctor to 'look like a doctor', ie be wearing relatively formal clothes and a white coat. Most felt more comfortable when attended by a doctor so dressed. It is important that patients can easily identify the attending doctor as such. Let's hear it for the white coat! M WELCH
Department of Vascular Surgery Manchester Royal Infirmary Oxford Road, Manchester M13 9WL
Munchausen 'How do I spell thee? Let me count the ways... The issue ofthe correct spelling of Munchausen is an oft recurring one in the English medical literature. Engel's letter (September 1991 JRSM, p 571) lamenting the loss of the Germanic double aitch and umlaut, represents a common failure to recognize the 'duality' of the famous Baron. Sakula and others1-4 have pointed out that it is necessary to distinguish between the raconteur Baron of historical reality, Karl Friedrich, Freiherr von Miinchhausen of Hanover and the fictional character based on him, created by Rudolf Erich Raspe, the redoubtable Baron Munchausen. The work entitled, Baron Munchausen's Narrative of his Marvellous Travels and Campaigns in Russia, was originally written in English by Raspe in 1785 using the anglicized 'Munchausen' spelling that was perpetuated in the subsequent English editions and later adopted by Richard Asher in describing his now famous syndrome. Inasmuch as the real Baron served only as a model and had no association whatever with the book, the use of the single aitch spelling is the proper one in referring to the imaginary Baron of the English literature and the syndrome which bears his name. The double aitch and umlaut form of Munchhausen should be reserved for the real Baron and the German translations of the Travels. R L GOLDEN
554 Larkfield Road
East Northport, NY 11731, USA References 1 Sakula A. More on Munchausen. Ann Intern Med 1977;87:798 2 Sakula A. Munchausen - fact and fiction. J R Coll Phys 1978;12:286-91 3 Golden RL. More on Munchausen. Ann Intern Med 1977;87:798 4 Golden RL. Spelling of Munchausen: An 'H' of a Mess. JAMA 1983;250:1975
NB: In association with the JAMA letter4 the following editor's note appeared: 'In the future, THE JOURNAL will use the English spelling, Munchausen when referring to the syndrome. - Ed.'
Scalp injury and skull fracture Although the conclusion in Mr Baneijee's interesting article on the unreliability of scalp injuries for predicting skull fractures (August 1991 JRSM, p 502) was clear, his message remained obscure.
