Jump to comment:
- Page navigation anchor for The continuity of care and effective clinical experience overcoming medicolegal vulnerabilityThe continuity of care and effective clinical experience overcoming medicolegal vulnerability
I have read the exciting research titled "Shared decision making between older people with multimorbidity and GPs: a qualitative study."1 Th research clarified the concept of a medicolegal vulnerability affecting shared decision-making (SDM) among older patients and GPs. Therefore, this study could vividly express the reality of SDM among them.
The strong point of the research is emphasizing the enhanced burden of multimorbidity on GPs in aging societies. Evidence-based medicine (EBM) has been educated in medical schools and can be applied to cases with less multimorbidity. However, managing older patients with multimorbidity has much uncertainty and involve multiple healthcare professionals. The complicated situations may make the process of EBM challenging and cause GPs and older patients to be less confident in SDM.
Effective SDM in multimorbidity of older patients demands quality in the continuity of care and clinical experience. As the previous article of the BJGP shows, experienced GPs acquire their abilities in SDM and EBM through multiple clinical experiences with reflection.2 Furthermore, experienced GPs respect the continuity of care for effective SDM among older patients with uncertainty caused by multimorbidity.3 Thus, for preparing medicine in aging societies, GPs should be educated effectively in clinical situations with deep reflection on their SDM and collaboration with various medical professionals...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Reducing medicolegal vulnerability: let’s evaluate decision processes, not clinical outcomesReducing medicolegal vulnerability: let’s evaluate decision processes, not clinical outcomes
I enjoyed reading Brown et al’s paper,1 and was particularly interested in the prominence of “medicolegal vulnerability” as a theme within their data. Over my decades as a GP, I became increasingly aware of this vulnerability and of my own reaction to it, practising increasingly defensively. This was one of several factors that led me to retire last year. When I first became interested in shared decision-making, I hoped that if I documented my discussions with a patient and the plan we ended up agreeing on, the patient would not complain (and find professional advisers to help them sue me) if they experienced a bad outcome that might have been averted by a different plan. Unfortunately, I can attest that this is not the case.
While I agree with Brown et al that tackling perceived medicolegal vulnerability may aid retention of GPs, I disagree that interventions targeted at perception are likely to help. What needs to change is the vulnerability itself. Claims for compensation for medical negligence (sic) are currently considered purely in terms of the management plan, focusing primarily on its likely effect on the outcome. In my experience, clear contemporaneous records demonstrating a careful shared decision-making process are dismissed by lawyers. It is possible that documented use of decision support tools may be dismissed less readily, but do we really want even more templates and tick-boxes than we use already?
Instead I sug...
Show MoreCompeting Interests: None declared.