A recent article published in the New York Times suggests that doctors could be immunized from malpractice liability if they were to follow clinical guidelines – the rationale being that if doctors used “evidence based guidelines” they could both improve quality of care and control costs.
Several problems exist with this theory. First, guidelines – despite their source may be unreliable. What works in one situation may not work in another. Complications may arise which require a physician to use his or her discretion to determine the best course of action. Following a guideline without modifying it based on the patient’s need may in itself be malpractice. Further, studies have shown that even when hospitals follow those guidelines – medical mistakes occur. The existence of “protocols” or “guidelines” does not prevent surgical errors. As recently reported in the New York Times, mistakes happen far too often, such as wrong site operations and the removal of a healthy organ rather than a diseased one.
Estimates suggest that the occurrence of mistakes has increased over the last several years. In fact, Dr. Stahel, director of orthopedics at Denver Health Medical Center states, “The data are shocking…[t]here are catastrophic events that are unacceptable. They have been termed a ‘never event’ – because they should never happen.”