FORT LAUDERDALE, Fla--Rather than increasing the number of medical
liability cases, good practice guidelines should actually decrease
the number of lawsuits, particularly frivolous ones, Frances H.
Miller told attendees at the first annual conference of the NCCN
(National Comprehensive Cancer Network). The meeting served as
a showcase for the Network's preliminary practice guidelines for
eight different cancers.
"The bottom line is, good guidelines based on good medicine
will be good law," said Prof. Miller, of Boston University,
where she is professor of law in the School of Law and professor
of public health in the School of Medicine.
There is widespread confusion and fear among physicians about
how practice guidelines will impact on liability issues, Prof.
Miller told the audience. Once doctors understand what constitutes
malpractice, these fears should be allayed.
"The medical malpractice standard is what doctors actually
do in practice. That is the standard of care you must meet,"
Prof. Miller said. If a physician practices good medicine, ie,
does what a similar doctor would do in a similar situation, he
or she has nothing to fear from the legal system.
Will Customary Care Decline?
But what doctors actually do varies immensely, she added, and
"customary" medical practice has changed over time.
"Customary medical practice in the past has led to some excess
care because we lived in a cost-pass-through reimbursement milieu,"
Prof. Miller commented. Now, with the "advent of managed
care with teeth," there is some concern that customary care
will decline to a level below that which is considered "adequate"
Good practice guidelines, however, will work to narrow the gap
between excess care and inadequate care, not only by cutting down
on substandard care, ie, getting care to underserved patients,
but also by cutting down on unnecessary care.