title: [Recent disciplinary committee rulings foster defensive medicine].
abstract: Recent medicolegal rulings corrected practitioners for not applying all possible interventions in the care of acute rare conditions. The performance was judged negligent, not on the clinical information available at the time, but in the light of the later course of disease. This paper argues that quality assurance requires a system of critical self and peer assessment, superimposed on medicolegal judgement. In all instances performance should be set against (external) criteria, including guidelines. Guidelines, in particular for general practice, define optimal care, to entitle patients to what is relevant while at the same time protecting them from ill-advised interventions. The point is made that the medicolegal ruling must be based on the same criteria that govern self and peer group assessment, and not on whatever it might be possible to do (maximal criteria), to prevent quality assurance from leading to defensive practice.
authors.affiliation: Katholieke Universiteit, vakgroep Huisartsgeneeskunde, Sociale Geneeskunde en Verpleeghuisgeneeskunde, Nijmegen.
authors.forename: C
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000208:Acute Disease / Q000191:economics; D003675:Defensive Medicine / Q000191:economics*; D006801:Humans; D009426:Netherlands; D018024:Peer Review, Health Care / Q000331:legislation & jurisprudence / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence / Q000592:standards*
vernacular_title: Recente tuchtrechtuitspraken bevorderen defensieve geneeskunde.