Lessons Learned: Risk Management Issues in Genetic Counseling

We live in a litigious society and nobody wants to be named in a medical malpractice suit. Genetic counselors, like all healthcare professionals, need to understand and manage their risks for being charged with malpractice. As the practice of genetic counseling continues to expand into mainstream medicine, it will be increasingly important for practitioners to have a keen understanding of their legal risks and steps that they can, and should take to protect themselves. In Lessons Learned: Risk Management Issues in Genetic Counseling, author Susan Schmerler provides a concise and understandable overview of sources of liability for genetic counselors as well as strategies for both avoiding malpractice suits, and for defending against such actions. The punch line can be found in the final chapter in which Schmerler offers the following advice: “Good practice is defensible practice.” She advises genetic counselors to keep their practice within the limits of their expertise, ensure that their skills and knowledge are current, understand the parameters of their professional duties and thoroughly and properly document their patient contacts. Drawing on her expertise in both genetic counseling and law, Schmerler has developed an invaluable resource for genetic counselors at all levels of experience. The book is well referenced and is written in a very clear, understandable language, with minimal use of “legalese.” Each chapter includes relevant examples to illustrate major points. The cartoons that appear at the start of each chapter are clever and serve as additional reminders of potential risks, and strategies for risk management in genetic counseling. The detailed table of contents, summary tables and four-page glossary of legal terms are helpful additions to the book. The first major section of the book provides an overview of the sources of liability for genetic counselors and includes an overview of tort and contract law, as well as federal and state legislation that address issues of interest to genetic counselors. Schmerler outlines the four elements of negligence malpractice lawsuits (duty, breach of duty, causation and damages) and devotes three chapters to a careful delineation of the elements of duty. The first of these includes an informative discussion of what establishes a professional relationship, and how contracting can be used to establish the parameters of the relationship. The following chapter, which includes a discussion of what constitutes “good practice” and how standards of care are established, is thorough and enlightening. Using genetic testing as an example, Schmerler examines the thought process that a practitioner might utilize in determining what tests to offer a client, by considering testing options on a continuum from those that we must offer because they are mandated by law and/or have a high probability of helping a client to those that we need not offer, as they would not be useful to the client, in the context of evolving standards of care. As Schmerler points out, standards of care are not static, are established by a variety of means, and are typically set by the profession. The need for genetic counselors to stay aware of and practice within current standards, and to achieve and maintain appropriate credentialing and, as available, licensure is clearly stated. A discussion of procedural requirements, such as documentation of contacts, confidentiality of medical records and elements of informed consent is presented in the last of this three-chapter sequence on the duty elements of negligence malpractice suits. As in the preceding chapters, the J Genet Counsel (2008) 17:408–409 DOI 10.1007/s10897-008-9157-0