President Obama's "solution" to the medical malpractice "crisis": you won't believe this one

In his State of the Union address, President Obama addressed the topic of "reform" of medical malpractice law.  The concept seems good (as do most during a Presidential speech), but you have to look past the semantics to get to the meat of President Obama's proposal.

President Obama proposes a plan to limit the malpractice liability of doctors who follow "clinical practice guidelines".  Sounds good if you're a professor at a university, but what does "follow clinical practice guidelines" mean to you and me?

"Clinical practice guidelines" is a fancy term for the standard of care that physicians must follow when treating a patient for a medical condition.  For example, clinical practice guidelines (a/k/a the "standard of care") require that physicians order imaging tests of the chest to rule out lung cancer when a smoker reports hemoptysis (coughing up blood--the number one symptom associated with lung cancer).  If the doctor does not follow clinical practice guidelines, and there is a delay in the diagnosis of lung cancer that diminishes the likelihood of the patient's survival, the doctor may face a malpractice lawsuit.

What does it mean in the context of President Obama's proposal to limit liability of physicians who follow clinical practice guidelines?  Not a damn thing.  Doctors are already required to follow clinical practice guidelines--it's called the "standard of care".  Malpractice lawsuits succeed or fail based upon whether the doctor followed clinical practice guidelines.

The clinical practice guidelines are often well-defined, as in the case of a heavy smoker presenting with hemoptysis, but just as often the guidelines are fuzzy.  Not every case has clearly defined clinical practice guidelines, but our President wants to put all malpractice cases in the same box.  Not so fast my friend.  How can physicians be exonerated for following clinical practice guidelines, when those guidelines often do not exist in many cases?  Herein lies the flaw in President Obama's rhetoric.

Let's take the example of a smoker, except in this case the smoker presents with enlarged lymph nodes in the armpits instead of hemoptysis.  Enlarged lymph nodes are known as adenopathy and they are a frequent sign of lung cancer, particularly in the armpits, but they are not nearly as ominous as coughing up blood.  Do clinical practice guidelines require imaging studies, such as a CT scan or x-ray of the chest, to rule out lung cancer in this example? Unfortunately, there is no clinical practice guidline for this example; in other words, there is no clearly defined rule as to what the physician should do.  If clinical practice guidelines don't exist, how would one apply President Obama's proposal for limiting malpractice? 

"Clinical practice guidelines" is a term that, when boiled down to its essence, really means "the rules" that apply to a physician's treatment of a patient.  Whether a physician deviated from the rules set forth by clinical guidelines is often the critical issue in a malpractice case, but this is nothing new--this issue has been the central part of malpractice lawsuits from the very beginning.

So what are we to take from President's Obama's proposal to limit the liability of physicians who follow clinical practice guidelines?  Unfortunately, it's nothing but rhetoric to mollify physicians, hospitals and insurance companies.  The rhetoric is meaningless. 

If you have any thoughts, positive or negative, I welcome your comments.  You can always reach me on my toll-free cell at 866-889-6882 if you want to speak with me directly.  I welcome your phone call.  If you want a FREE copy of my book, The Seven Deadly Mistakes of Malpractice Victims, you can request the book from the home page of my website at www.protectingpatientrights.com.