LETTER
Practice Guidelines and malpractice Litigation
Edward E. Bartlett, PhD
1 October 1995 | Volume 123 Issue 7 | Page 556
TO THE EDITOR:
I am writing in response to the recent article by Hyams and colleagues [1].
I have done many reviews of malpractice claims files. As a rule, legal proceedings are handled by lawyers outside the insurance company. Claims files contain only a summary of the case, not the details of the legal strategies or sources of evidence being considered. Thus, it is not surprising that only 6.6% of claims files reflect use of practice guidelines, when 48.1% of attorneys report such use per year.
Of greater concern is the authors' conclusion, based on their review of claims files, that guidelines were used more frequently by plaintiffs than by defense attorneys. Their sample size of only 17 does not qualify for a pilot study and makes statistical analysis difficult at best.
On the basis of P values of 0.114 and 0.148, respectively, the authors assert that two variables "showed a trend toward significant association" with use of practice guidelines. A P value greater than 0.10 cannot be viewed as showing any statistically significant trend.
The authors conclude that the use of guidelines by plaintiff attorneys may "chill" physician's interest in the topic. It is regrettable and ironic that this study has garnered so much negative publicity from the lay and professional media [2], when actual experience with practice guidelines shows that they have succeeded in influencing physicians' practice patterns [3], in improving quality of care [4], and in reducing malpractice claims [5].
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Author and Article Information
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Georgetown University; Washington, DC 20007-2195
1. Hyams AL, Brandenburg JA, Lipsitz SR, Shapiro DW, Brennan TA. Practice guidelines and malpractice litigation: a two-way street. Ann Intern Med. 1995; 122:450-5.
2. Felsenthal E. Doctors' own guidelines hurt them in court. Wall Street Journal. 19 October 1994: 1.
3. Grilli R, Lomas J. Evaluating the message: the relationship between compliance rate and the subject of a practice guidelines. Med Care. 1994; 32:202-13.
4. Bartlett EE. Practice guidelines: how risk managers can tap the benefits, avoid the pitfalls. Rockville, MD: Edward Bartlett Associates; 1995.
5. Stephenson G. Guidelines take the pain out of malpractice premiums for anesthesiologists. Report on Medical Guidelines and Outcomes Research. 1990; 1:4-6.
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