An outstanding plenary session on defensive practice
A family physician, member of the Scientific Committee for this 5th edition of Preventing Overdiagnosis and member of the QMA’s Board of Directors, Dr. Guylène Thériault chaired a very popular plenary session on the theme of Tackling the defensive practice argument. Three speakers discussed this topic from different angles.
Using a real case to illustrate, Audrey Ferron Parayre, an assistant professor at the Faculty of Law at the University of Ottawa, showed the value of shared decision-making between physicians and patients. This collaborative discussion forms the basis of consent to care and ensures proper communication between the patient and physician. Knowing that communication issues are generally at the centre of professional liability cases, improved patient-physician communication is much better legal protection than engaging in defensive practices.
A lawyer specializing in bioethics, Michel T. Giroux started off by reminding us that the key issue in ethics is the goal of the procedure. He then presented a case history where the patient’s death was likely caused by questionable clinical decisions, but which addressed the wishes of threatening relatives. The foundation of a healthy helping relationship is built on professional competence and the imperative of non-maleficence, or primum non nocere. A health professional could potentially harm a patient, even in the absence of malicious intent. Defensive practice is a professional stance intended to shelter the agent from legal action. Professionals who engage in defensive practices are moving away from the intended goal of a helping relationship, which is to seek the well-being of the patient. The emotion guiding professionals is fear. When this emotion is not addressed, it prevents the professionals from exercising their freedom to practice in the interest of the patient.
Dr. Lorraine LeGrand Westfall, Director of Regional Affairs and Chief Privacy Officer at the Canadian Medical Protective Association, clearly demonstrated the difference between the guidelines issued by professional orders and those issued by peer associations, while also differentiating the claims under the judicial process. Dr. LeGrand Westfall also talked about the code of ethics for physicians. She reminded everyone of the importance of not using resources unnecessarily and that physicians must give priority to the best interests of patients by providing them with the relevant information to help them make a free and informed decision when discussing tests or procedures.