Malpractice fears long have prompted resentment and defensiveness among physicians. But when it comes to reform, malpractice is a lot like sex in the '90s. People think and talk about it, but really don't do much about it.
However, one area of medicine that has been slowly reformed is the attitude toward practice standards. Practice parameters that prove cost efficient and clinically sound have been accepted by the medical mainstream. Healthcare administrators and insurers even have made progress in convincing physicians of the need to compare themselves with peers on outcomes and cost-effective clinical habits. One sweetener in changing behavior is telling physicians that following guidelines is a good courtroom defense.
That's why it's discouraging to hear that written practice standards have become powerful weapons for plaintiffs in malpractice cases. As The Wall Street Journal put it: Doctors are getting burned by cookbook medicine. Unfortunately, that development will only fuel the fire of fear among physicians who aren't sold on following guidelines and measuring outcomes.
To head off a crisis in confidence, healthcare administrators and medical staff directors should refocus their strategy on practice standards.
First, they should show physicians bona fide examples of how guidelines and outcomes evaluations have improved clinical performance, saved money and brought more contracted business to hospitals.
Second, bring in physician speakers, corporate health benefits managers and managed-care experts to brief the medical staff on the merits of accountability.
Third, issue a position paper stating that treatment protocols are guidelines and not legal standards. Emphasize that physicians always have the ability to circumvent guidelines if the patient's condition and medical history merit special treatment.
Finally, remind the media and the legal community that practice parameters are meant to educate physicians, not to clobber them in the courtroom.