Conventional wisdom could be wrong in primary care

Mar 29 2005

A study by Mark Hall, J.D., professor of law and public health sciences at Wake Forest University Baptist Medical Centre, is suggesting that conventional wisdom could be wrong in that primary care doctors who coordinate the care of their patients by specialists may actually have lower liability risk than primary care doctors who do not attempt care coordination. But many doctors believe otherwise, in a survey of 1,238 practicing physicians, 49 percent listed legal liability as one of the two main barriers to care coordination.

Hall and his colleagues however found that care coordination by physicians does not in fact increase the threat of lawsuits or result in higher malpractice insurance premiums.

Care coordination involves establishing and monitoring a comprehensive treatment plan which embraces the recommendations of all specialists and resolves conflicts regarding medication, treatment or patient behaviours. Primary care doctors review the overall management of the patient’s multiple conditions, encouraging compliance with recommendations of the specialists and taking steps to prevent future problems. But many primary care doctors don’t try to coordinate care beyond recommending that their patients see specialists.

Inadequate care coordination can result in patients with multiple chronic conditions having to cope with a complex and inefficient system of care.

Such patients account for more than half of all medical spending and often have to endure higher rates of avoidable complications and hospitalizations. Improving care coordination could substantially improve health outcomes and lower costs and also reduce medical errors.

Physicians worry about liability because the concept creates a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes, therefore it is important to remove any perceived barriers to better care coordination by physicians.

According to the experience and judgment of experts in medical liability, there does not appear to be any basis for physicians who perform care coordination to have serious concerns about liability. Patients with chronic illness are not more likely to sue, and courts will not hold primary care physicians automatically responsible for mistakes made by specialists just because the primary care physician is coordinating the patient’s care.

Hall explains that courts only hold doctors responsible for what the doctor does, and not what other doctors might do wrong.

Hall and his colleagues concluded that rather than increasing liability, care coordination may lower liability risks. “Every medical function carries some liability risk and care coordination is no exception, but the extent of these risks appears to be broadly commensurate with other risks to primary care practice,” the authors write.

Hall’s co-authors were Ralph A. Peebles, J.D., professor of law, and Richard W. Lord Jr., M.D., assistant professor of family and community medicine, both at Wake Forest Baptist.

The report is published in the March/April issue of Annals of Family Medicine.

Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine, and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report.