To the Editor.
—The article by Garnick et al1 is a useful summary of an important topic, the potential effect of practice guidelines on malpractice claims.Professional liability claims are a crude and inefficient way to assure the quality of medical practice and to compensate patients for bad outcomes. Bad outcomes may result from inappropriate process or improper implementation, or may occur despite appropriate processes implemented properly. Compensation for the latter is a social-justice, not a quality-of-care, issue. We know from industrial examples that building quality into the product is far preferable to postproduction inspection to identify products that are meeting standards. Malpractice claims are the ultimate inspection. They generate fear, manifested in defensive medicine, and offer few incentives to assure quality. Practice guidelines offer enormous potential to improve practice, to reduce avoidable bad outcomes and, possibly, eventually to reduce malpractice claims.In assumption 1, the authors describe a
Goldschmidt PG. Can Practice Guidelines Reduce Malpractice Claims?. JAMA. 1992;267(19):2602–2603. doi:10.1001/jama.1992.03480190044018