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Addressing Variations in Healthcare Quality: The Role of Medicine and the Law


Held Friday, May 20, from 1:00 p.m. to 2:15 p.m. Eastern time.

Health Lawyers' Spring 2005 public interest teleconference series began with Addressing Variations in Healthcare Quality: The Role of Medicine and the Law. The speakers were:

  • Elise Dunitz Brennan, Partner, Doerner Saunders Daniel & Anderson LLP, Tulsa, OK (moderator.)
  • Philip G. Peters, Jr., J.D., Ruth L. Hulston Professor of Law, University of Missouri-Columbia School of Law, Columbia, MO
  • John E. Wennberg, M.D., M.P.H., Director, Center for the Evaluative Clinical Sciences, Peggy Y. Thomson Professor for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH

Dr. Wennberg and Professor Peters discussed their research on variations in healthcare quality within three categories of care—effective care, preference-sensitive care, and supply-sensitive care—and their recommendation that malpractice liability and informed consent laws be based on standards of practice that are appropriate to each category of care.

In the case of effective care, the legal standard should be that virtually all of those in need should receive the treatment, whether or not it is currently customary to provide it. For preference-sensitive care, the law should recognize the failure of the doctrine of informed consent to assure that patient preferences are respected in choice of treatment; Dr. Wennberg and Professor Peters suggested that the law adopt a standard of informed patient choice in which patients are invited, not merely to consent to a recommended treatment, but to choose the treatment that best advances their preferences. In the case of supply-sensitive care, Dr. Wennberg and Professor Peters suggested that physicians who seek to adopt more conservative patterns of practice be protected under the “respectable minority” or “two schools of thought” doctrine.

Dr. Wennberg participated in Health Lawyers’ recent Public Interest Colloquium, “Medical Necessity: Current Concerns and Future Challenges.” His comments on the teleconference included insights he gained at the Colloquium on potential linkages between his research on practice variations and efforts to improve the policies and guidelines that govern medical necessity determinations. Time was provided for questions and discussion with callers.

The $25 registration fee paid for one connection charge and allowed as many individuals as would like to participate on a speaker phone from that site.

Speaker's Biographies

Teleconference Materials:
Wake Forest Law Review (article)
Practice Variation in Medical Necessity (presentation)
Variation in Use of Medicare Services Among Regions and Selected Academic Medical Centers: Is More Better? (article)

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