From my America Out Loud Pulse podcast with Dr. Lawrence Huntoon –https://www.americaoutloud.com/ego-must-not-trump-patient-care/
When clinical practice guidelines were first introduced, they sounded like a good idea. Some experts in a certain field of medicine would get together and decide what is the best thing to do for patients. It didn’t take much time for the flaws in the guidelines concept to emerge. We saw that some of the recommendations were designed to save money rather than benefit patients. Some guidelines appeared to be influenced by the companies who would make money from their use—aka Big Pharma. We certainly learned during Covid-19 that the experts were not always right and were corrupted by influence from pharmaceutical companies.
Medicine traditionally is full of all sorts of information and differing opinions. After all, the human body and its reaction to medications and other treatments are not always predictable. Continually questioning the so-called settled science is how progress is made. It became clear to discerning physicians that these guidelines became a crutch, promoting “cookbook” medicine and as my guest puts it, “eliminates unproductive time spent taking the patient’s individual circumstances, conditions, and needs into consideration so as to provide optimal care.”
Worse yet, these guidelines have been used a weapon against good, innovative physicians, sometimes to crush a competitor or someone who refuses to sell his practice to a large group. The critics of innovative physicians conflate the guidelines with the “standard of care”—the standard of practice to which physicians are legally held. This is a legal definition of good medical practice in a community with the same resources as the physician at issue. What constitutes the standard of care will change from community to community as well as evolve over time. Guidelines may be considered as a factor, but they do not define the standard of care.
In the 1995 South Carolina malpractice case, McCourt v. Abernathy, the Court stated:
“The mere fact that the plaintiff’s expert may use a different approach is not considered a deviation from the recognized standard of medical care. Nor is the standard violated because the expert disagrees with a defendant as to what is the best or better approach in treating a patient. Medicine is an inexact science, and generally qualified physicians may differ as to what constitutes a preferable course of treatment. Such differences due to preference…do not amount to malpractice”.
My guest and I will discuss these issues and how needlessly attacking doctors harms patients.
