Can Practicing EBM Help Protect You From Malpractice Claims?

Kathleen Satterfield DPM FACFAOM

When a DPM is facing a jury preparing to decide his or her fate in a malpractice trial, the podiatrist would probably have paid a lot more attention to evidence-based medicine (EBM) protocols if the DPM had realized that the outcome of the trial would have depended on whether he or she had used EBM.

What? You mean there is an everyday, in-the-trenches use for evidence-based medicine? For the busy clinicians out there who have thrown their verbal brickbats at EBM, this may finally get their attention. If you do get sued for malpractice, some say you may not be as likely to be found guilty if you practice according to EBM principles.

This is the word out there in medico-legal circles these days and it makes good common sense. Unfortunately, “good common sense” does not always make it into courtrooms so I went looking for data to back it up.

What I found was eye-opening. Peter Orszag, former White House director of the Office of Management and Budget, made my search very easy with his recent New York Times column (http://www.nytimes.com/2010/10/21/opinion/21orszag.html?scp=1&sq=malprac...) .1 He called for a “much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.” Who among us cannot agree with that?

What none of us knew was that in 1972 there was a little known provision in the Social Security Act amendments. This provision provided immunity from malpractice liability for those doctors who were treating patients in conformity with standards “set forth by so-called quality improvement organizations – nonprofits under contract with Medicare that work to improve care. The provision remains in force, though those organizations have yet to set such standards,” according to Orszag.

The emphasis above is mine. This is an opportunity for our boards and the American Podiatric Medical Association to set up those standards as they relate to podiatric medicine and surgery. Malpractice suits are a nuisance to well-trained, ethical podiatric physicians. Let us put the 1972 amendment into effect.

Reference

1. Orszag P. Malpractice methodology. New York Times, Oct. 20, 2010.

Comments

Once we have national scope of practice laws and all have three years of residency, this is very probable.

Who in the APMA would set these standards and how would it affect the broad spectrum of what the current training and expertise levels are nationwide?

One issue with this is that the bureaucrats may end up setting policy and we all know where that leads. "Who says I can't/shouldn't do that??" A man behind a desk somewhere replies "I DO!!!". It is happening now with insurance carriers and claims authorizations or "peer to peer reviews". How would this affect those situations?

Foot and ankle is a small field and there is little true EBM here so far.
Most of what we do is based on some expert opinion or small studies.
Quality research is very difficult and may be even impossible in some cases.
For example, there is little or no quality evidence that one osteotomy is better than another.

Most clinical docs have no idea what real research is. And "expert panels", while somewhat useful, do not represent EBM.

Vladimir Gertsik DPM, NY

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