All is not well, that ends well !
Treatment guidelines in cardiology practice are periodically published by ACC/AHA/ESC.These guidelines represent the current scientific practice. They are called some times as recommendations. Medical professionals tend to adhere to this guidelines whenever possible.They are not legally binding in most of the countries.In USA some states believe it, to be legally binding.
The problem with these guidelines are , they are classified as class 1 ,class 2 , class 3 recommendations.
Class 1, A drug , device or a procedure Is definitely useful and must be prescribed.
Class 3, A drug , device or a procedure Is not useful and should not be used .
Class 2*, A drug , device or a procedure may be useful or may be harmful , and hence may be used or may not be used . (Vaguest possible guideline!)
*Altered to convey the meaning
What are the guideline violations that can be sued in court of law ?
A person with established CAD who is not been prescribed a statin (Cholesterol lowering drug) can be sued straight away, even if the patient has no adverse outcome due to the nonprescription of that drug. The issue here is , the doctor has not prescribed a drug which has proven benefit .The law is clear on that .Most will agree that, the doctor is at fault , and he is never protected even by their colleagues .He can’t defend his action.
What are the medical errors that can never* be sued in court of law !
But the same doctor who opens up a totally occluding coronary artery in an asymptomatic patient(CTO -chronic total occlusion) and lands up in a complication and the patient dies. This could be major guideline violation as opening a CTO in an incidentally detected , asymptomatic patient is a class 3 recommendation. Neither the physician, patient , institution nor the regulatory authorities bother about this even though there is strong case for censure , in reality it never happens. Number of experts from leading hospitals do this procedure in live work shop all over the world with full media glare, It is an irony the same experts are only writing in their guidelines that these procedures should not be done inappropriately.
And this medical error ( Should we call it a crime if it is knowingly done ! ) keeps growing as the physician never feels guilty about it .
The message here is
A physician of a state of the art hospital, in a scientifically advanced country goes scott free and guilt free even if he openly violate the scientific guidelines and do a inappropriate procedure that result in a patient death. Mean while a small time physician in a remote place in the same country can be taken to task for not prescribing a officially recommended drug (By standard guidelines) .He will be labelled unscientific and unethical even if his non prescription , had not caused any untoward health outcome .
In short , in today’s modern medical practice
Even a ” Minor error of ommision” attracts guilt and perceived fear among the physicians. Meanwhile many of the ” Major errors of commission” done by professionals are rarely frowned upon and thus these mistakes continue to perpetuate !
*There should be a strong provision in medical law to address the issue of inappropriate procedures even if the procedure has not resulted any untoward effect to the patient.
Dr.S.Venkatesan MD 
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