Guidelines don’t boost potential for litigation

Some clinicians are wary of practice guidelines, fearing that they will increase the number of medical malpractice claims. But not Maryanne McGuckin, DrSc Ed, MT, senior research investigator at the University of Pennsylvania School of Medicine in Philadelphia. Research shows such concerns to be unfounded, says McGuckin, who was instrumental in developing the practice guideline for the diagnosis and treatment of venous leg ulcers. She found during a literature review that guidelines, when developed by appropriate experts and based on valid scientific data, do not adversely influence the amount of malpractice litigation.

In one 1995 study published in the Annals of Internal Medicine, researchers examined 259 malpractice claims from 1990 through 1992. Only 17 involved practice guidelines. In four of those, defendants were exonerated on the basis of practice guidelines, and in 12 claims, practice guidelines were used to implicate the defendant physician. In one case, the guideline played no part in the final decision.

Other researchers report that guidelines were used equally by plaintiffs and defendants in medical malpractice claims. McGuckin concludes that failure to adopt a guideline can place the clinician at risk for medical malpractice claims, and that by following a valid guideline clinicians greatly improve their chances for prevailing in litigation.

McGuckin also noted that, in a Journal of Internal Medicine survey of more than 1,500 general internists and medical subspecialists, the factor that most determined whether a guideline was adopted by practitioners was its endorsement by respected colleagues. Reimbursement for recommended services was found to be least important.