The digital ink was barely dry on our last post about the sometimes questionable and largely non-evidence-based nature of clinical guidelines, when the Justice Department decided to weigh in on the topic. As if to underscore Dr. Rich’s assertion that “guidelines are no longer guidelines”, the Federal government has raised the prospect of fining your doctor and/or sending her to prison for the crime of not strictly following guidelines of care. As reported by MedPage Today:
“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable cardioverter defibrillators (ICDs), the Heart Rhythm Society has told its members.
In a mailing sent to HRS members, the group said it had been contacted by the Department of Justice to assist in a probe of ICD prescribing.
“[HRS] has agreed to assist in an advisory role to lend expertise concerning proper guidelines for clinical decision making,” according to a copy of the notice posted by two members on the Internet.
The notice indicated that the society was prohibited from commenting further on its role in the investigation. Justice Department officials could not be reached for comment.
It was therefore unclear whether the probe is related directly to a report in the Journal of the American Medical Association earlier this month indicating that ICDs are often prescribed for patients who don’t qualify for the devices under published guidelines…
The HRS notice appears to raise the possibility that the Justice Department may be considering prosecution of individual clinicians, in addition to its already disclosed investigation into alleged payola schemes by ICD manufacturers.”
If the Justice Department investigation is, in fact, going to target clinicians based upon their adherence to guidelines, the American healthcare system is headed down a very slippery slope. Government regulators and prosecutors will, of course, contend that they’re simply looking for “waste, fraud and abuse”, and that looking for non-adherence to guidelines is a reasonable screening tool when looking for criminals. But let’s not kid around. Any such policy is going to have a chilling effect on treating patients as individuals rather than statistically average widgets. You may need a test or procedure as a part of good medical care, but your doctor is going to be too scared to order it if her record of “guideline compliance” is at stake.
Think about it. For the first time your doctor may have a real choice to make if your medical condition doesn’t happen to fit neatly into some academic cookbook. Adhere to the guideline and commit malpractice, or violate the guidelines and risk jail time.
Using guidelines in this way is unscientific, unethical and just plain wrong.