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[Recent disciplinary committee rulings foster defensive medicine]
1Katholieke Universiteit, vakgroep Huisartsgeneeskunde, Sociale Geneeskunde en Verpleeghuisgeneeskunde, Nijmegen.
Abstract:
Recent medicolegal rulings corrected practitioners for not applying all possible interventions in the care of acute rare conditions. The performance was judged negligent, not on the clinical information available at the time, but in the light of the later course of disease. This paper argues that quality assurance requires a system of critical self and peer assessment, superimposed on medicolegal judgement. In all instances performance should be set against (external) criteria, including guidelines. Guidelines, in particular for general practice, define optimal care, to entitle patients to what is relevant while at the same time protecting them from ill-advised interventions. The point is made that the medicolegal ruling must be based on the same criteria that govern self and peer group assessment, and not on whatever it might be possible to do (maximal criteria), to prevent quality assurance from leading to defensive practice.
Insights
Medicolegal rulings should not judge past medical practice by future knowledge. Quality assurance requires self and peer assessment against guidelines, not maximal intervention, to prevent defensive medicine.
Area of Science:
- Medical Law
- Quality Assurance
- Clinical Practice
Context:
- Recent medicolegal rulings have scrutinized practitioners for not employing all possible interventions for acute rare conditions.
- Judgments were based on the later disease course, not contemporaneous clinical information, leading to negligence findings.
Purpose:
- This paper advocates for a quality assurance system integrating critical self and peer assessment with medicolegal judgment.
- It argues for performance evaluation against external criteria, such as clinical guidelines.
Summary:
- Guidelines, especially in general practice, establish optimal care standards, ensuring patients receive necessary interventions and are protected from unnecessary ones.
- Medicolegal rulings should align with these self and peer assessment criteria, avoiding 'maximal criteria' evaluations.
Impact:
- Implementing this approach can prevent quality assurance from fostering defensive medical practices.
- It aims to ensure fair and consistent evaluation of medical performance, balancing patient care with practitioner protection.