Med Mal Reform = Practice Guidelines?

Side Note: As we all know, the health care reform bill signed into law over a year ago had little to say about med mal reform. Yet, the Obama administration has mentioned several times over the last few months their interest in med mal reform. Finally, this past week we saw a tangible attempt at medical liability reform –but is it enough and is the proposal any good?

The Obama administration has suggested that physicians practice evidence-based medicine and follow clinical practice guidelines in their practices. If they do so, the Obama administration says that those physicians should have immunity or limited liability from med mal lawsuits. This sounds great at first, but then falls apart upon closer inspection.

Essentially, the Obama administration is putting the cart before the horse. Whose guidelines should be followed? Which guidelines are the best? Lots of organizations put out clinical guidelines: insurance companies, medical specialty societies, med mal insurance companies, patient advocacy groups, etc. Lots of organizations have an interest in how medicine is practiced and how patients are treated.

Thus, before we say that physicians should use clinical guidelines, we need to create objective, universally agreed upon guidelines. Is this even possible? Can guidelines be created that are agreeable to physicians, insurers, professional medical liability insurance companies, medical societies, and patient advocate groups? Even if this is possible, there, of course, can’t be a guideline for every clinical situation out there. And, interestingly, possibly one of the biggest problems with this proposal is that those who create the guidelines ultimately bear NO liability. It is the docs who follow them that do. Does this make any sense? The author of the article below comments on this and poses his own, unconventional solution to this problem. Read on for his take on how to handle this.

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A Market Solution for Malpractice
Published: March 28, 2011

IT’S been a year since health care reform was signed into law, and since then both Republicans and Democrats have been trying to address one item it left out: medical malpractice reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the malpractice liability of doctors who follow clinical practice guidelines — in effect, granting them immunity.

Doctors love this proposal, and patients should too: When doctors follow good guidelines they are less likely to order too many or too few tests or to prescribe the wrong treatment.

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