WASHINGTON--Put GAR in your patients' records. It can prove extremely
useful should you find yourself being sued for medical malpractice,
Marvin A. Dewar, MD, JD, said at the National Conference on Prevention
and Early Detection, sponsored by the American Cancer Society.
GAR is an acronym for "general information, alternatives,
risks"--three key points every physicians needs to discuss
with patients before cancer screening or diagnosis,
Dr. Dewar, director, Family Practice Residency Program, the University
of Florida College of Medicine, Gainesville, said that malpractice
cases alleging that a physician delayed diagnosis or failed to
diagnose a cancer continue to increase.
In a 1991 Florida study, Dr. Dewar and his colleagues found that
in cases involving primary care physicians, failure to diagnose
cancer was the most common allegation, representing 16% of all
paid claims, at an average cost of $160,352. Failure to diagnose
breast cancer ranked first, followed by lung, prostate, and colon
One element in defending against such lawsuits is having and documenting
a good informed consent process. And thus, he recommends remembering
"Informed consent is a conversation that you as providers
have with patients," Dr. Dewar said. "It is the understanding,
the meeting of the minds between the patient and the provider.
The documentation of the informed consent is not informed consent,
but it is important from the legal protection standpoint."
He urged that physicians give each patient general information,
explain the alternatives, describe the risks, and note this in
the patient's record.