As we know, the American Medical Association was part of the consortium that offered to voluntarily rein in health care spending over the next decade.
I’ll leave it to the health policy blogs to discuss the implications, but of course, everyone is asking, “What’s in it for me?”
The AMA tipped their hand a bit in a recent WSJ Health Blog post. It’s well known that President Obama, along with the influential former director of the Congressional Budget Office, Peter Orszag, place significant weight on the Dartmouth Atlas data decrying the variations in care across the country.
So, if doctors can follow strict, evidence-based guidelines, should they be sued if they stay on track? The AMA suggests not: “[AMA President-elect James] Rohack said that following evidence-based guidelines, such as those created by medical specialty societies, could be a way to reduce those variations. But some docs may worry that they could be sued for skipping a test “” even if the guidelines recommend against the test. Giving some liability protection to doctors who follow the guidelines might change that . . . helping to reduce the number of tests and slow the growth of health costs.”
So, they are acknowledging and embracing the data that is very influential in the White House, as well as in progressive health policy circles, and parlaying that into reasonable malpractice reform.
I think it’s a smart play.
Related posts:
- Nancy Snyderman: Is she aware of any evidence-based guidelines?
- Who monitors clinical guidelines?
- Will patients accept the new, evidence-based, breast cancer screening guidelines?
- Is evidence-based medicine appropriate for the elderly?
- Is evidence-based medicine desirable?
- Why patients will reject evidence-based medicine
- Marc Siegel apparently doesn’t care about evidence-based medicine
{ 15 comments }
Kevin,
I try everday to practice evidence-based medicine and make clinical decisions based on the data. I do not want protection from anything and feel if i do things the “right way” even if i am sued there is no real case. I refuse to practice defensive medicine.
I don’t want to resort to guidelines for legal protection. Instead, I will continue to try to exercise sober judgment documented in the medical record. I also record that that that the patient understands the alternatives and makes the decision. There is no airtight legal immunity strategy. I still think that good medicine – well documented – is our best legal defense.
wwwMDWhistleblower.blogspot.com
I think another question is – what can the AMA actually do with respect to liability protection? Regardless of whether a particular physician is practicing evidence-based medicine, there will always be individual patients who, for whatever reason, will resort to lawsuits. Even if without merit, they are expensive and are damaging to the reputation and the well-being of the health care providers involved. Now, if the AMA could prevent a suit from even happening (it would have to pass through an AMA gauntlet even before the physician heard about it), that would be interesting…
How would you actually KNOW what the doctor did until you file suit? The doctor isn’t going to give you that info under oath without filing suit, and it may or may not be clear from the record. Physicians always complain that it’s the fact of being sued that’s the worst thing, but often that’s the only way a patient can get them to explain what happened.
I wouldn’t put too much stock into this plan keeping you from being sued. You’d be better off to spend more time with your patients.
Rein in healthcare spending? That’s very funny. Let’s see, we’re going to add more people to the system, and thus more votes, and then some politician is going to try and reduce the amount of care available?
This “promise” is laughable at best.
And the AMA as part of this reduction? Really? I think Kevin is pulling our legs.
The AMA makes the following claim:
“The practice of defensive medicine is also a major factor in rising costs. A 2003 Health and Human Services (HHS) report estimated the cost of defensive medicine to be between $70 and $126 billion per year.”
Putting aside the fact that the craziness of estimating the number is illustrated by the wide variation between the high and the low, it appears that the AMA has redefined the term “major”.
Given that total health care expenditures in the US are some 2.4 trillion dollars, even the high estimate would be approx 1/2 of 1% of costs. And that assumes we would eliminate it totally.
Physicians should be wary of their lobbying organization hopping in bed with an Administration pushing single payer. Particularly when they assume you can’t even do basic math.
Doctors should have some sort of liability protection if their decision making has a sound scientific reasoning to it. Whether we admit or not defensive medicine is a fact. We cannot live in denial about that. Just look at the ER admission thresholds in any hospital for a case as common as a chest pain. You will find mega defensive medicine being practiced.
It(He,She) is lamentable these things, because a time ago behind wise that the medical services were a problem for many persons and up to the moment they neither find they do not even give any solution, apparently the government forgot what promised and it is now where it is that to there be remembered(reminded), before that is very late, the medical assurance is important for many people, like that they indicate it in findrxonline, the web page that delivers a lot of information about this debate.
“Doctors should have some sort of liability protection if their decision making has a sound scientific reasoning to it”
They already do. Doctors themselves establish the standard of care, and often it’s even lowered via the locality rule.
“You will find mega defensive medicine being practiced.”
Why? We keep hearing they do it, but no one seems to be able to show it works. We know what DOES work to reduce their exposure to lawsuits-better communication with patients-but doctors don’t get paid to do that, so it doesn’t seem to be a priority.
“Its a smart play”. No… it’s a political play. Its a play that doesn’t understand the meaning of guidelines at all.
Guidelines are simply just that. A guide. They are not rules, and they filled with “weasel words” like “low blood pressure” or “fast heart rate” or “high temperature”. These words are interpretable by each individual. Therefore, there is no way to tie the practice of medicine to a guideline as a source for EXACTLY how a diagnostic or therapeutic pathway should evolve.
Guidelines should not be tied to the medical-legal system. As stated above. We are bound by the standard of care. Doing so protects you from being found negligent. But nothing will protect you from being sued. However, as we all know, good communication and compassion is what will reduce your risk of being sued.
Where’s Dr. Merenstein when you need him?
http://www.kevinmd.com/blog/2004/05/evidence-based-medicine-up-for-trial.html
What would that have to do with anything? It’s one side of one case.
That’s like relying on a drug trial with one patient who only tells his version of what happened to make a decision.
There are so many problems with these, following them is almost medical malpractice.
The IDSA did this with Lyme diagnostic and treatment guidelines and have initiated witch hunts after doctors who diagnose or treat outside of those guidelines.
Anonymous – It is interesting that you think all a doctor needs to do is talk to their patients in order to avoid a lawsuit. I assume, you are not a physician yourself or otherwise involved in medicine, or you would understand the greater picture and necessity for Tort reform.
A wonderful cardiologist I happen to know was sued by a family stating that he did not force their family member to have a cardiac catheterization and subsequently died. He discussed with this patient the fact the chances of his death without the testing and possible intervention was very high. He documented what he told the patient. He documented that the patient refused to have the test. He still got sued. He was devastated because that lawsuit deems him negligent, when he did everything he could to get that person to choose the testing. He lost the lawsuit. The judge overruled the finding. The appeals court ruled with the jurors. People use lawsuits as another form of winning the lottery in this country….and they see doctors and hospitals as easy targets.
Comments on this entry are closed.