Why 'Choosing Wisely' Won't Protect You in a Lawsuit

William Sullivan, DO, JD


October 27, 2017

In This Article

How Intently Should You Follow Professional Association Guidelines?

As with Choosing Wisely recommendations, guidelines promulgated by professional medical associations can be a valuable source of information for medical treatment decisions. Such guidelines are often researched and vetted by experts before being published, and compliance with professional association guidelines can be used during a malpractice case to show that a physician's treatment was within the standard of care.

However, just as with other types of guidelines, failing to comply with a guideline's recommended courses of action may infer that a physician negligently managed a patient's condition. Before deciding to rely on guidelines from professional medical associations, it is wise to review the studies and evidence supporting those recommendations. In some instances, even "strong" guidelines have been based on inappropriate data which, in turn, needlessly increases a physician's potential medical malpractice risk.

Consider the 2013 guidelines for use of intravenous thrombolytics in the management of acute ischemic stroke, developed in a collaboration between the American Academy of Neurology and the American College of Emergency Physicians (ACEP).[5]

These guidelines gave the highest "Level A" recommendation for administering intravenous thrombolytics in patients suffering from an acute ischemic stroke, meaning that the guidelines represented "Generally accepted principles for patient management that reflect a high degree of clinical certainty (i.e., based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues)."

However, of 12 high-quality trials regarding thrombolytic use in stroke, two studies showed patient benefit, six studies showed no benefit, and four studies showed increased patient harm (including increased rates of mortality and intracranial bleeding).[6] A public outcry by emergency physicians after the publication of the thrombolytic guidelines caused the ACEP Board to open the guidelines for comment on ACEP's website, but the results of the comments were never made public and the policy was never rescinded. A poll of readers in Emergency Physicians Monthly showed that 88% of respondents believed that ACEP's thrombolytic guidelines needed to either be rescinded or revised to reflect the current standards of care.[7] [Disclosure: Dr Sullivan is a senior editor at Emergency Physicians Monthly.] In addition, after the guidelines were published, an article in the British Medical Journal noted that several of the guideline authors failed to disclose their associations with the manufacturer of the thrombolytic being used in the guidelines.[8]

Despite a strong "Level A" recommendation from several professional organizations, these stroke guidelines showed potential harm to patients and continue to be questioned by most practicing physicians.


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