In Cohen MH, Eisenberg DM. Potential physician malpractice liability associated with complementary/integrative medical therapies. Ann Intern Med; 2002;136:596-603, my colleague David M. Eisenberg, M.D. of Harvard Medical School, and I offer a framework for physicians grappling with medical liability issues as complementary and integrative health care practices are made available in conventional medical settings.
The framework offers a way to assess potential malpractice liability issues in counseling patients about complementary and integrative therapies. The framework classifies complementary and integrative therapies into four categories, according to whether the evidence reported in the medical and scientific literature (A) supports both safety and efficacy; (B) supports safety, but evidence regarding efficacy is inconclusive; (C) supports efficacy, but evidence regarding safety is inconclusive; (D) or indicates either serious risk or inefficacy.
Physicians across the country have offered feedback that this is a helpful framework and rough gauge for clinical practices that are legally defensible. Our framework, for example, was incorporated into an article in the Annals Special Series on Complementary and Alternative Medicine authored by my colleague Wendy A. Weiger, M.D., Ph.D. and others. This article, Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer, summmarized the prevailing evidence regarding CAM therapies for cancer. When I called the medical directors of integrative care units at several hospitals some months later to interview them for a project sponsored by the National Library of Medicine, and asked them how they decided what therapies to use, they responded: “Oh, we use the Weiger Framework!”
Our article provides clinical examples in each category to help guide the clinician on how to counsel patients regarding use of complementary and alternative medical therapies in a given clinical situation. The bottom line is this: look to the most current medical evidence regarding safety and efficacy; this is a changing map both in conventional and in CAM care.
We also offer specific strategies to reduce the risk for potential malpractice liability. Our strategies include the following: 1) determine the clinical risk level; 2) document the literature supporting the therapeutic choice; 3) provide adequate informed consent; 4) continue to monitor the patient conventionally; and 5) for referrals, inquire about the competence of the complementary and alternative medicine provider.
This framework should help provide a good basis for clinical decisions involving complementary and integrative care.