Legal risks of clinical practice guidelines

Well-crafted systemically developed clinical practice guidelines (CPGs) are intended to frame current medical knowledge in a manner that will assist health care providers in delivering high quality care. CPGs are being used in the malpractice arena to define a credible standard of care to measure the accused physician for an alleged problem addressed. This may occur despite a medical society's disclaimer that they are not intended, nor devised, for that purpose. It can be argued that CPGs may be used with greater effect by the plaintiff's bar for inculpatory evidence than by the defense as an exculpatory standard. Physicians should be aware of the legal use of CPGs and the associated risk management implications. Physicians who write guidelines for medical societies may wish to consider the potential future courtroom use of CPGs as they attempt to use evolving research to enhance patient care. A fine line may separate a "best practice" from acceptable quality care; the former may not be expected to occur in all patient care interactions. Suggestions embedded in a CPG rather than other publication may be legally interpreted incorrectly as a baseline standard of care expectation.