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The course will educate the clinician on key legal issues and general liability risk management principles involved in advice to patients concerning use or avoidance of CAM therapies and/or inclusion of CAM providers in clinical care. Among other things, the course will draw on our article published in the Annals of Internal Medicine, setting forth a framework for clinicians. In that article, we observed that malpractice is defined as unskillful practice, which fails to conform to a standard of care in the profession, and results in injury. The definition cuts across therapies whether regarded ‘conventional’ or ‘CAM,’ yet the inclusion of CAM therapies often raises questions in the clinician’s mind regarding the application of these principles to requests involving CAM therapies. Courts generally rely on medical consensus regarding the appropriateness of a given therapy, so that the level of evidence regarding safety and/or efficacy can be taken as a good barometer of potential liability in recommending (or alternatively, allowing inclusion of) such a therapy. Thus, our suggested framework asks whether the medical evidence for any therapy (whether conventional or CAM):
(a) supports both safety and efficacy;
(b) supports safety, but evidence regarding efficacy is inconclusive;
(c) supports efficacy, but evidence regarding safety is inconclusive; or
(d) indicates either serious risk or inefficacy.
In the article, we urged that, depending on whether the therapy fell within region (a), (b), (c) or (d), the clinician could, accordingly, (a) recommend (with caution), (d) avoid and discourage, and (b)-(c) allow but monitor efficacy and safety respectively. Liability accordingly would be (a) unlikely, (d) likely, (b)-(c) uncertain, though probably more likely if safety were clearly at issue. We gave clinical examples to guide physicians, with the caveat that as the medical evidence changes over time, therapies can shift across the spectrum of safety and efficacy, and hence of liability risk, accordingly. We also offered a number of liability risk management strategies for the clinician, including—most importantly—continuing conventional monitoring and intervention as necessary; and suggestions concerning informed consent in situations involving concurrent use of CAM therapies.
Original Release: 3/28/2006
Most Recent Update: 1/1/1900
Termination Date: 1/1/1900
NUMBER OF CREDIT HOURS:
The Harvard Medical School designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
COST: $20.00
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OVERALL LEARNING OBJECTIVES:
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Discuss key legal and clinical practice issues governing the issue of responding to requests from patients to referrals to complementary and alternative medicine ("CAM") providers such as acupuncturists, chiropractors, and massage therapists.
- Introduce key legal and clinical practice issues facing clinicians advising patients concerning patient use or avoidance of complementary and alternative medical (CAM) therapies (such as acupuncture, chiropractic, or herbal medicine (e.g., St. John’s Wort) in clinical care.
- Present a risk management framework containing strategies to minimize liability risk and responsibly advise patients concerning use or avoidance of CAM therapies.
- Describe and discuss informed consent requirements pertinent to CAM therapies.
CLINICAL LEARNING OBJECTIVES:
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Provide guidance to clinicians who are asked to respond to patient requests concerning use or avoidance of CAM therapies.
- Teach clinicians a risk management framework to assess whether to recommend, discourage, or accept patient use of CAM therapies based on the evidence.
- Show clinicians a profile of clinical situations that may be legally risky when advising patients concerning CAM therapies.
- Link clinical evidence to likelihood of liability surrounding use of CAM therapies.
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