The Value of Clinical Practice Guidelines as Malpractice "Safe Harbors"

A long line of research has found substantial gaps between the care that patients should get and what is actually provided—a quality “chasm,” according to the Institute of Medicine. One problem is overservice, driven by physicians’ fear of lawsuit for failure to use all available methods to diagnose or treat a patient. This “defensive medicine”—extra tests and procedures done principally to forestall lawsuits or defend them if brought— increases costs and reduces quality.

Reliable clinical practice guidelines have potential to help by authoritatively stating standards of good care in advance. They promise a rare trifecta—better medical quality, more cost restraint through limits on liability’s influence over medicine, and a potential avenue for political compromise on malpractice reform.

This paper from the Urban Institute, on behalf of the Robert Wood Johnson Foundation, discusses the promise of clinical practice guidelines as medical liability “safe harbors.” The paper examines how guidelines can protect providers, how they would prevent defensive medicine, and challenges and hurdles in designing and applying such guidelines. The paper also outlines recent medical liability reform proposals that would leverage guidelines, and how safe harbor guidelines could reduce medical overspending.

The paper suggests that following a good guideline should provide some liability protection, to an extent that will likely increase with time. Regardless of the fate of guidelines as liability safe harbors, the authors conclude that it remains important to press forward with generating good, evidence-based advice for clinicians and patients.