Orszag's malpractice proposal, cont'd
A reader who researches health-care policy questions e-mailed to say he was not impressed by Peter Orszag's proposal to develop "best practices" checklists and then protect doctors who follow them from medical-malpractice lawsuits. The problem, he said, is that we've had zero success agreeing on what "best practices" are:
As someone whose research is on evidence-based medicine and agrees circumscribing docs decisions is a great way to lower costs and improve quality, you have way, way more faith in clinical practice guidelines than I do. They are mostly specialty societies trying to justify their existence.
When AHRQ said don't do meaningless back surgery they were almost shut down. Ditto USPSTF and mammograms. (They're reportedly still being muted.) When PSA screening was found at best marginal for lowering prostate cancer mortality the American Urological Assc said we should test PSA younger, b/c that's why the studies were negative. Negative trial -> recommend more utilization.
Much more importantly, I still think anyone who reads the article quickly will see it as being about limiting malpractice, about which he is totally, totally wrong.
Another commenter tried to apply Orszag's proposal to a specific case:
One malpractice case that I know about involved a cancer patient who died. There are published protocols for treating various types of cancer. The primary reason that the doctor was sued was that she didn't follow the protocol. The doctor diagnosed the cancer incorrectly, so if he had decided to follow the protocol she would have been following the wrong one. Had that occurred, I don't know whether the doctor would have been sued for following the wrong protocol; I'd say the odds are against it. Had the doctor made the correct diagnosis and followed the relevant protocol, she would not have been sued.
Orszag's proposal would not have changed the incentives for the doctor very much. If the doctor had followed the treatment protocol, she could still have been sued over the erroneous diagnosis. I don't think that Orszag's proposal would change that. If she had made a correct diagnosis and followed the protocol, any malpractice suit against her would have been without merit. I don't think that Orszag's proposal would have changed that, either.
For those who want more, commenter Eunomia recommended this paper by Texas law professor Ronen Avraham as a more sophisticated and fully-fleshed out argument for using standardized-treatment guidelines to immunize doctors from medical malpractice suits.
| October 25, 2010; 9:00 AM ET
Categories: Health Reform
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