“Top Dog Gets You Top Dollar.” “Injured? Tell us your story.” “We Win or It’s Free.” “Philly’s Legal Champion — Personalized, Aggressive Representation.” The highways of my city, Philadelphia, are festooned with the billboards of personal injury and malpractice lawyers. They float above the traffic, urging us to view any injury, accident, or bad outcome as an opportunity to extract multimillion dollar jury awards and settlements from each other and from our institutions.
As a doctor passing these billboards daily, I believe a sick culture is being nurtured. These signs sap citizen morale, punish the economic engines of our city, and intimidate and demoralize health care workers, physicians in particular. One of these signs even appears to be on the actual boundary of the Hospital of the University of Pennsylvania’s property line. The juxtaposition shocks me every time I drive past the hospital and its hardworking, hard-healing patients inside.
Billboards, and the messages they broadcast, affect us. Contrast the following two examples. Fresh off a stirring pregame pep talk, the Notre Dame football team players all touch a hallowed sign that reads “Play like a champion today.” They emerge from a tunnel into the light of the stadium to thunderous cheers and applause, ready to be heroes. But Philadelphia area doctors and health care workers, already fighting burnout and compassion fatigue, drive with stooped postures through a morning gauntlet of intimidation, with reminders that “Even one small mistake can be ruinous today.” What exactly is it that we are getting ready for today?
In a litigious culture such as the one promoted by the billboards, malpractice cases can run into the millions. Two cases from this year alone deserve mentioning. In the first, a former Philadelphia Eagles football player sued a preeminent orthopaedic surgeon and his group after an attempt to fix and rehab his shredded knee did not work well enough. The suit came to trial during the lead up to the Eagles’ Super Bowl appearance in February 2023. Beloved Eagles players testified on their teammate’s behalf, dazzling a starstruck jury more than the humdrum medical experts called to defend the surgeon could. Ultimately, the case resulted in a $43.5 million jury award, $29.2 million of which was slapped upon the singled out, well-respected surgeon.
In the second case, a record-breaking verdict against the Hospital of the University of Pennsylvania was handed down by a jury of lay people in the staggering amount of $180 million for claims related to an alleged delay to perform a C-section. Lawyers for the defense argued that the injury occurred before the patient arrived at the hospital, and that the mother received “appropriate and timely care” from doctors and other staff. Relitigating the trials is beyond the scope of what can be done in the public domain. What cannot be undone or denied, however, is the chilling effect such jury awards have on the doctors and health care workers who show up each day trying to do their best, and who can never prevent every bad outcome. The reflexive mistrust we as patients feel learning of such allegedly heinous mistakes cannot be undone either.
Such astronomical awards, coupled with billboards advertising "top dollar" to a poor city, combine to create a public perception of justice served with lottery-sized opportunities. But this is a mirage. The vast majority of truly injured patients and parties never see a dime of compensation. Doctors are often personally blamed and financially punished for human mistakes, system errors, or what juries of lay people have decided perhaps went wrong. According to research highlighted by the American Medical Association (AMA), 34% of all practicing doctors have been sued. Over 50% of doctors over age 55 have been sued. 63% of ob-gyns and surgeons have been sued. Most patients lose their cases, but each one costs on average over $30,000 to defend. Health care systems, and the thousands of jobs they maintain, are degraded financially and sometimes existentially by such litigation. But this system must enrich someone. Some lawyers whose faces and jingles grace Philadelphia highways spend $100 million a year on advertising and billboards alone.
There are potential solutions to the malpractice conundrum for injured patients and human physicians. According to an article published on the AMA website, “Traditional reforms such as caps on noneconomic damages have proven to be successful in maintaining a stable liability climate in the states that have enacted them. The AMA has called for federal funding for pilot projects to test concepts such as health courts, liability safe harbors for the practice of evidence-based medicine, early-disclosure-and-compensation models, expert witness guidelines and affidavits of merit.” The goals of such pilots would be to ensure stable health care economics, sustain high risk specialists whom we all need, and protect standards of good medical care. Further, such pilots would fairly compensate many more injured patients — and do so in a way that does not feel like a jackpot for injury lawyers.
This current runaway system is too large for any one person to tackle, but on a personal level it impacts me every working day. I feel guilty, ashamed, and accused despite the fact that I love my actual patients and they love me back, apropos of this city of brotherly love. Driving my little 2012 Toyota Prius with 150,000 miles on the odometer beneath massive beacons of intimidation reminds me that there is an inexhaustible force ready to pounce upon any bad outcome or mistake I make. The Philadelphia Eagles, like the Notre Dame football team, would find recruitment of new players impossible if instead their pregame touchstone read: “Play like you will be ruined professionally, financially, and spiritually if you make a mistake today.” I wonder, do patients driving under the same signs feel a similar corrosive effect? Does it spill into their next examining room visit with a doctor who now appears poised and indeed destined to injure them?
Solutions and just compensation for the majority of injured people will not be easy. But I know the answer cannot be more solicitous legal billboards corroding the public domain and spirit of Philadelphia, a proud city that is built upon community, mutual respect, and the basic dignity of working people. Speaking for the health care profession at least, we have good intentions and sacrifice much.
And so, if you are driving through Philadelphia, or the hardworking town or city near you, know that these signs are not beacons of opportunity and justice. Rather, they are: wedges between many imperfect people of good will; illusory promises of justice; and stealthy vehicles of outrageous profit for the few.
How do you feel about the malpractice culture hanging over your practice of medicine? Share in the comments.
Ryan McCormick is a family physician and writes Examined, a newsletter about primary care and life in medicine available on Substack. He has been doing entirely clinical work for two decades, and lives in South Philadelphia. Dr. McCormick is a 2023–2024 Doximity Op-Med Fellow.
Illustration by Jennifer Bogartz
