I had asked a similar question about 6 months ago and really didn't
get a good answer. In America we practice 'Defensive medicine', which
is sad as, patients and physicians often embrace the concept that all of
us are 'immortals', and even in Morbidity &Mortality's people are often
found challenging others when a 80 yr old nursing home patient dies due
to cerebral aspergillosis. Some senior professors have been heard to
say-"you know , probably this guy lived his life and it was his time to
go."
Experts who are called by lawyers, to testify might not be aware of
principles of EBM and testify based on 'opinon' of experts, which form
the last category in the evidence ladder. Until unless we have an
uniformity where we train our experts to think in terms of probability,
and in ebm we will never come to a clear solution. Critics have blamed
probability as a term used for a physicians explanation not to do a
test(even though it might be inappropriate). Some of the screening
tests have more of a political base than being determined by hard
science.We need outcome based evidence and an impartial practice of
medicine which is based on the information from literature. I understand
we are probably several decades behind this form of practice. Till the
pundits in Medicine come out with bolder recommendations and discuss
this issues at the level of the Senate and convince the public that the
motive behind not ordering a test is not to cut cost, but to avoid
getting a false positive result, our practice of medicine is going to be
one long ordeal. A legal expert said , everytime you see a patient
plan your encounter., as if you are going to do everything to avoid a
law suit. Practising medicine can be very stressful under these
circumstances as we understand the level of uncertainity in our daily
practice.
Fortunately for us all patients don't think alike.
Harold Sox in one of his commentaries has indicated that if after
explaining every thing to the patient, the patients still wants to have
the test done, then do it.
Allen Shaughnessy wrote:
>
>
> I can't seem to talk for more than about 10 minutes to any group of
> U.S. physicians without someone saying, "yes, well, EBM may be the way
> to go. But if I don't practice medicine like my colleagues do, I'll
> get sued."
>
> Does anyone know the state of affairs regarding the affect of practice
> guidelines or an evidence-based approach, positive or negative, on
> malpractice liability?
>
> Allen
>
> Allen Shaughnessy, PharmD
> Director of Research
> Harrisburg Family Practice Residency
> PinnacleHealth System
> P.O. Box 8700
> Harrisburg, PA 17105-8700
> 717-231-8651
> [log in to unmask]
>
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