PEDIATRICS Vol. 95 No. 1 January 1995, pp. 104
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DOCTORS' OWN GUIDELINES HURT THEM IN COURT

J. F. L. MD

Doctors are finding that they can get burned by cookbook medicine.

Recent court cases, as well as a Harvard University study, suggest that written guidelines on how to treat particular medical conditions have become powerful weapons for plaintiffs in malpractice cases. Where plaintiffs once had to rely on hired experts to argue that a procedure was botched, they can now point to official treatment recipes issued by physician groups themselves.

"Lawyers like me are using them in court all the time to say, "Gee, your own organization says this is a minimum standard of care, and you didn't follow it."

Ironically, doctors have embraced and developed guidelines in recent years, believing they could be used to fight malpractice suits. "The hope was that guidelines would say specifically what the standard of care was," says Troyen Brennan, a health law expert and an author of the Harvard study.

Medical groups have issued dozens of guidelines, from instructions on performing Caesarian deliveries to recommendations on treating intoxicated trauma patients ... the Harvard study warns that the rising use of guidelines in malpractice litigation could "chill physicians' interest" in writing new ones.

According to the Harvard study, which was released earlier this year by the School of Public Health, such guidelines are about three times more likely to be used against doctors than in their defense. The Harvard researchers examined 13 years of court decisions and 259 claims filed with malpractice insurers.

Where it's clear that a doctor met the required standards, the guidelines can aid physicians.