I had a corneal transplant back when I was just a kid. The doctor never told me how to recognize rejection because supposedly "only five percent of the world's population has immune systems that would recognize something so small."

Unfortunately, I fall into that five percent. The day the surgeon pulled stitches from the eye, I thought the starting haziness was the aftermath of stitch removal.

In a few expensive hours, I was told the graft was lost due to rejection and the "greasy film" was an inflamed, thickened cornea.

The eye was flooded with ophthalmic steroids to halt septicity.

The steroid flooding destroyed my lens, which led to a second surgery to remove the lens and insert a replacement. Then, I formed thick scar tissue and the doctor used a laser to try to get that scar tissue down.

I waited over twenty years for another transplant in that eye. The eye was beat up and no doctor wanted to touch such a banged-up mess.

Several years ago a gifted and heaven-touched ophthalmologist did an exemplary new transplant.

Yet my wait was for naught! You see, the original surgeon - all those years back - missed the scar tissue and hit my PUPIL with his laser.

I can't use ambient lighting. I surround myself with pricey ultra-maneuverable lighting to get the light just right.

I wear special shades when I go outside to block out as much sunlight as possible. Oncoming car lights at night make me a scared and blinded Bambi.

I was totally blind for a while.

Light will never fall properly in this eye. No one knows, yet, how to sew "tissue paper" pupils very well.

Lawyers, so far, won't even hear me out - outright cutting me off - once I get past the year of the initial surgery and the year of my discovery. STATUTE OF LIMITATIONS!

As I write, the front of my blouse is wet because I just can't stop the tears. They never stop when this subject comes up.

I do my math and I agree with this author. You, surgeons and others, that think he is so off the mark, take my place for a day!

If my "good" eye, for what ever reason, runs into any problem, I will again find need to touch all the food on my plate to orient myself before eating.

I won't visit Amazon so much because I've been raped of something so very, very precious and irreplaceable...

From my standpoint as a physician, I found the objective data very provocative. However, I consider Tom Baker's conclusions and interpretations based on the data misguided and inflated. I consider that the book is useful to read, as it contains accurate data based on research. However, his interpretation and representation of the data to support his views that there should be more litigation and access to litigation than there is today against medical professionals only serves to promote his bias against medical professionals working in good faith in an imperfect world.

I can do no better than the detailed criticisms of this book already posted. Having practiced surgery for over 30 years and an author myself, I'll tell you Baker's attitude is an example of what's driving health care in this country toward mediocracy and away from the high quality our nation could achieve if physicians were just left alone to do their job. The book itself is a symptom of ITBED (Ivory Tower Blind Eye Disease,) ignoring the real problems plaguing our health care system. They are two-fold -- the lack of appropriate reimbursement and lack of tort reform. (If you don't believe the latter, check out the state of Texas.)

Everyone quotes Baker's facts. Well, look at the medicals schools -- you don't have to have an "A" average to get into one. Look at the residency programs in our country --they're having trouble filling them! Why don't smart kids want to be doctors?

You really want to know what's happening? Don't read this book, ask your doctor! And ask him or her now, because there may soon be a time when you'll be in the need of emergency care and someone will just hand you a mouse and tell you to surf the net for your treatment. You see, if your doctor explains all the options to you, it might confuse you so much, you won't be able to make a decision and you might wind up suing the doctor. This actually happened and the jury found in favor of the patient. The doctor explained too much! Do you get it? We can't win!

I heard a plantiff lawyer lecture recently and he said two things were necessary before proceeding with a malpractice suit -- a deep pocket and an injury. John Edwards is running for President of our nation and that's how he made his fortune. Hillary's health plan was worse than socialized medicine. The other guy won't salute our flag. God bless us everyone.
- Constance Uribe, M.D., F.A.C.S.

Baker begins by putting malpractice insurance expenditures into perspective. In 2003, doctors, hospitals, and other health professionals paid only about $11 billion in medical malpractice premiums - out of $1.5 trillion spent on health care, and in comparison to $116 billion Americans paid for personal auto liability and no-fault insurance.

Part of the "problem" is its unpredictable and cyclical nature. Medical malpractice payouts are significantly influenced by a few cases drawn out over several years - thus, when they occur insurers can find themselves needing to temporarily raise rates to recoup losses. Another problem is that doctors bear most of the costs of medical liability, despite receiving only about 15% of health care revenues. And finally, the issue focuses primarily on a few specialities - eg. OB-GYNs.

As for the costs of defensive medicine, early 1990s research by a congressional group found doctors reporting defensive they would take extra defensive medicine costs less than 0.01% of the time in response to various situations posed to them, though at a much greater rate in some situations (eg. when heart disease or brain surgery was involved). These results have been inappropriately generalized, and subsequently largely contradicted by the original authors since concluding that managed care eliminated the impact without increasing malpractice awards. The number of doctors supposedly leaving the profession to avoid malpractice costs has also been overstated (eg. they simply moved to another area), but malpractice rates have led to a decline in part-time practitioners in high-risk areas - a good thing given that malpractice rates are inversely related to practice volume.

Baker believes that malpractice suits are beneficial, citing anesthesiologists' working identify major sources of malpractice awards and thereby significantly reducing errors and holding insurance rates constant over a number of years. He believes that the real medical malpractice problem is that there are too few claims - most instances where patients are harmed due to medical errors do not result in lawsuits, thus not creating incentive and feedback to improve. Therefore, Baker offers several suggestions for improving the rate of lawsuits.

Baker does not go on to look at wastes in other areas of health care. Dr. Relman, however, does. He estimates ("A Second Opinion" that 40-45% of health care expenditures are waste - excess administration, profit, and care that is either not needed or of doubtful value. Others estimate that the new Medicare drug benefit alone adds about $70 billion/year in wasted costs through extra overheads and lack of competitive bidding.

Baker begins by putting malpractice insurance expenditures into perspective. In 2003, doctors, hospitals, and other health professionals paid only about $11 billion in medical malpractice premiums - out of $1.5 trillion spent on health care, and in comparison to $116 billion Americans paid for personal auto liability and no-fault insurance.

Part of the "problem" is its unpredictable and cyclical nature. Medical malpractice payouts are significantly influenced by a few cases drawn out over several years - thus, when they occur insurers can find themselves needing to temporarily raise rates to recoup losses. Another problem is that doctors bear most of the costs of medical liability, despite receiving only about 15% of health care revenues. And finally, the issue focuses primarily on a few specialities - eg. OB-GYNs.

As for the costs of defensive medicine, early 1990s research by a congressional group found doctors reporting defensive they would take extra defensive medicine costs less than 0.01% of the time in response to various situations posed to them, though at a much greater rate in some situations (eg. when heart disease or brain surgery was involved). These results have been inappropriately generalized, and subsequently largely contradicted by the original authors since concluding that managed care eliminated the impact without increasing malpractice awards. The number of doctors supposedly leaving the profession to avoid malpractice costs has also been overstated (eg. they simply moved to another area), but malpractice rates have led to a decline in part-time practitioners in high-risk areas - a good thing given that malpractice rates are inversely related to practice volume.

Baker believes that malpractice suits are beneficial, citing anesthesiologists' working identify major sources of malpractice awards and thereby significantly reducing errors and holding insurance rates constant over a number of years. He believes that the real medical malpractice problem is that there are too few claims - most instances where patients are harmed due to medical errors do not result in lawsuits, thus not creating incentive and feedback to improve. Therefore, Baker offers several suggestions for improving the rate of lawsuits.

This book is a must read for anyone who thinks that tort reform is a good idea. We've tried it in California. The effect has been to effectively immunize health care providers from liability by closing the courthouse door to claims of medical negligence. There is no incentive to improve the health care system or to address the systemic problems that cause most injuries and deaths.

Medical negligence is a fact. Our government estimates that as many as 98,000 people per year die from preventable medical errors. The cost of these errors is enormous and, when our civil justice system is crippled by tort reform, those costs are often shouldered by the public through increased taxes and fees.

Tort law is designed to do two things: to provide just and reasonable compensation to people injured by the negligence or carelessness of another and to discourage behavior likely to result in injury. When we "dis-incentivize" good medical practices by immunizing health care providers, we make it more, not less, likely that people will be injured as a result of medical errors.

There is no evidence of which I am aware that these reforms have benefitted anyone other than big insurance companies. In California, it is increasingly difficult or impossible for patients who are injured by medical errors to receive "just and reasonable" compensation for the harm caused. The cost of litigating such cases is prohibitive in light of the 32-year-old MICRA cap which limits damages to $250,000 in most cases - even those involving gross negligence or the death of a child.