www.njchiropractors.com I 21 X-ray of an area treated was a deviation from the standard of care. They take this position even if there is no clinical indication for X-ray and do not address the unnecessary exposure of the patient to radiation.” A review of the literature provided little additional benefit to the above responses. CPGs have been used by the legal profession and other third parties both as a “liability shield” to defend or support a doctor’s patient care decisions and actions, and as a “liability sword” to those who don’t adhere to them. Most malpractice cases are decided on the state level, and evidentiary rules vary widely from state to state. CPGs are general and may not reflect what is considered customary care for the locale and situation of the doctor providing care. From the responses I conclude the following: 1.  Adhering to a CPG can be problem- atic if a doctor deviates when treating a patient and a bad clinical outcome occurs. This is in spite of the fact that the two are likely not associative or causative. The CPG can be interpreted by attorneys and others as a “standard of care” that may be a potential liability. 2.  CPGs can be used by third party payors as a standard of care for medical necessity and a rationale for denying services. 3.  Utilizing guidelines can be an asset when dealing with third party payors in justifying and supporting medical necessity. They can be used with patients and the others to establish care plan parameters and to validate care. They can be an asset for defense in a legal liability case, but the benefit may require strict adherence to them. 4.  We care for patients, not guidelines. Patients too often don’t follow the clinical algorithms. Many CPGs represent an idealized situation, not the complexities and “messiness” of actual patient care. Doctors need to apply CPGs as a clinical tool rather than a prescription. Adherence to a CPG should never be at the expense of a doctor’s clinical judgment in a particular case. 5.  The main reason for an association to adopt guidelines is to set up a minimum standard of care for their members to follow. Their members would have to agree to follow them and the accompanying liabilities. The question of whether an association should be involved in recommending clinical care directives is one that must be undertaken by its leadership. In summary, the main risk of CPGs comes not from their use, but from their misuse. They can be used and distorted to serve the agendas of insurance companies, plaintiff and defense attor- neys, or professional groups. Guidelines are best utilized as they are intended, as guides to better patient care. They inform and interpret the latest clinical research findings, professional consensuses, and current thinking that individual practitioners may not have the time, resources, or inclinations to do. They are not dictates or directives, and should never be positioned as such. David Graber, DC, CCSP, DACBSP, is the chairman of the ANJC Council on Technique and Clinical Excellence. He maintains a private practice in Parsippany, NJ. All the products you need...and the personal service you deserve. Electrotherapy • Laser Therapy • Shockwave Therapy Magnetic Resonance Therapy • Tables • Traction • Thermo Stim Rehab Equipment • Cardio Equipment • Over 5000 Clinical Supplies Dynatronics • Chattanooga • Hill • Multi Radiance Lloyd • Scifit • Quantum...and more 800.345.1124 www.harlanhealth.com Foot Levelers Single Foot Kiosk Start your experience today. 800.553.4860 FootLevelers.com • Fast • Easy to use • Engaging • Cloud-based