The co-authors of this article include former Obama administration officials Dr. Ezekiel Emanuel (former White House health care advisor and brother to Rahm Emanuel, former White House Chief of Staff), Dr. Donald Berwick (former head of Medicare), and Peter Orszag (former budget director).
One of their proposals caught my eye, because it's a clever way to use the tort system to ensure physician compliance with government practice guidelines:
A more promising strategy would provide a so-called safe harbor, in which physicians would be presumed to have no liability if they used qualified health-information-technology systems and adhered to evidence-based clinical practice guidelines that did not reflect defensive medicine. Physicians could use clinical-decision support systems that incorporate these guidelines.In other words, if doctors follow government practice guidelines (and use government-approved electronic medical record systems), they will be protected from malpractice lawsuits. But if doctors stray from those guidelines and anything goes wrong, they must take their chances in court. This will create tremendous pressure on physicians to practice government-approved “cookbook medicine.”
Given that physicians have been clamoring for many years for "tort reform" and other measures to alleviate the medical malpractice problems, I'm sure many will be very tempted by this "solution", even if they give up enormous clinical autonomy in the process.
And if you're a patient who is a clinical outlier (such that the standard treatment protocol doesn't work for your particular condition), you may have a harder time finding a doctor willing to diverge from those guidelines.
Standardization of treatments may sound good in theory. But the problem is that patients don't come in standardized packages.
(Read the full text of the NEJM piece, "A Systemic Approach to Containing Health Care Spending".)
