An interesting Forbes article this weeks offers some thoughts on the increased focus placed on “patient engagement’ to prevent medical mistakes and improve the overall care provided in hospitals and medical clinics. The post author suggests that proper engagement with patients may soon be molded into the reasonable “standard of care” analysis upon which all medical professionals are judged. Of course, this sort of thinking may one day have implications on possible legal actions.
The Complexity of Standards of Care
The basic idea behind the “standard of care” is reasonableness. Did the medical professional act reasonably when providing care? In many cases, the answers is clearly yes or no, but there are many cases that fall in the “gray” area. Those gray area cases are usually the most vigorously litigated.
In addition, a standard of care changes over time. As more information is learned, new technologies are developed, and evidence comes in on the efficacy of treatments, the details of a “reasonable” course of conduct change. It is in that vein that some wonder if common-sense patient engagement will make its way more clearly into standard of care analyses. In other words, if doctor fail to engage a patient in simple ways that would have prevented an error, did that doctor breach the standard of care? As more information arises on the benefit of having patients involved in their own care, the logic behind including these assessments in reasonableness analyses grows.
Undoubtedly, discussion of changes to these evaluations will come with criticism. For example, some challenge whether the threat of medical malpractice lawsuits cause “defensive medicine” or the overuse of certain drugs or testing merely to prevent a possible malpractice suit. Some medical professionals claims that money can be saved by eliminating this unnecessary medical care.
Of course, these complaints ignore the other red herring in the room–the fact that our system is still based on a fee-for-service model. In other words, while it is easy to point fingers at lawyers and injured patients, medical professionals have an obvious incentive to provide more treatment, regardless of the need, when they are paid for that treatment. This arrangement is like a real estate agent telling you the exact size house that you should buy and your life depends on it. Would it be any surprise that the agents would recommend far larger homes–with the side benefit of their commission increasing?
Patient Safety Should be Priority
An additional benefit of adding patient engagement to the standard of care is that there is little to no cost. Taking a few brief moments to engage the patient in their own care and ask more pointed questions that might prevent unnecessary or harmful care would have a range of benefits. The costs are almost non-existent.
This is far different from most other changes to reasonableness standards for medical professionals. For example, over time it may become reasonable for a certain test to be performed to identify a possible problem when a patient exhibits certain symptoms. Performing that test has clear financial costs. When the test seeps into the standard of care, its use will likely go up. That will assuredly happen here, if doctors are held accountable for patient engagement, they will ensure it occurs. But that engagement does not have a cost–and there is little to lose by taking the time to practice this common sense safety step.
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