Medical Standards of Care

What are medical standards of care?

Are they supposed to connote quality and safe medical care? Or are they supposed to connote what majority of the medical professionals are practicing? Or both?

Here are some definitions of terms found in the Internet:

Standard:
something established by authority, custom, or general consent as a model or example or CRITERION 
something set up and established by authority as a rule for the measure of quantity, weight, extent, value, or quality

Medical Definition of Standard of Care:

1. A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.  (New England Journal of Medicine, 2004)

2. In legal terms, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient’s care under the same or similar circumstances. The medical malpractice plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached.

https://www.medicinenet.com/script/main/art.asp?articlekey=33263

Medical standard of care

standard of care is a medical or psychological treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical and/or psychological professionals involved in the treatment of a given condition.

1. Diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance. Adjuvant chemotherapy for lung cancer is “a new standard of care, but not necessarily the only standard of care”. (New England Journal of Medicine, 2004)

2. In legal terms, the level at which an ordinary, prudent professional with the same training and experience in good standing in a same or similar community would practice under the same or similar circumstances. 

https://en.wikipedia.org/wiki/Standard_of_care

The “medical standard of care” is typically defined as the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances that led to the alleged malpractice.

What Does ‘Standard of Care’ Mean?

If you have a medical malpractice case (or think that you might have a medical malpractice case), you may have heard of the concept of standard of care, but what does it actually mean?

The first thing to know is that standard of care is a legal term. It is not a medical term. That means that it is primarily lawyers, not doctors, who use the term. In general, the only times that most doctors talk or think about the standard of care is when they are testifying in court on medical malpractice cases or when they are attending medical malpractice seminars.

Standard of care means the degree of care and skill of the average health care provider who practices the provider’s specialty, taking into account the medical knowledge that is available to the physician. Another way to describe the term is that the standard of care is based on the customary practices of the average physician, i.e., what the average physician would customarily or typically do in similar circumstances.

With all the above definitions that can be seen in the Internet, how should lay people and physicians regard medical standards of care?
My personal thoughts, perceptions, opinions and recommendations (TPORs) on this:

Medical standards of care should focus primarily on standards or processes of quality and safe medical care rather than on what majority of medical professionals are customarily practicing.

What majority of medical professionals are customarily practicing does not ensure that they constitute quality and safe medical care.

The best scenario, however, is that majority, if not all, of the medical professionals are practicing the standards or processes of quality and safe medical care. 

Thus, one has to start first with what constitutes the standards or processes of quality and safe medical care and then have these standards and processes taught and eventually practiced by all medical professionals.

The most important question or challenge is what constitutes the standards or processes of quality and safe medical care.  

Should they be based on the published “evidence-based clinical practice guidelines”?

Ideally, yes, but not all evidence-based clinical practice guidelines guarantee quality and safe medical care.

For the evidence-based clinical practice guidelines to serve as medical standards of care, they should be comprehensive (meaning covering all areas and aspects of medical care, which is quite a gigantic task); analyzed and constantly reviewed for effectiveness to the local setting (again, another gigantic task); and analyzed and constantly reviewed for applicability and acceptability in the local setting (another gigantic task).

My suggestion is to start with defining the universal processes of quality and safe patient management that will be acceptable to all medical professionals and laypeople.  Note, just the processes first.  After the processes are defined, gather and input the data and information needed for the problem-solving and decision-making processes in patient management.

See my recommended patient management process framework and write-ups below.

mgt_pt_framework_rj_12jun30

mgt_of_a_pt_framework_roj_16dec31

 

After the processes are defined, gather and input the data and information needed for the problem-solving and decision-making processes in patient management.  Formulate evidence-based clinical practice guidelines.

I personally prefer the health-process-evidence based clinical practice guidelines as they are more applicable and acceptable to the local setting.

hpecpg_advisory_13sept1

1233425_10151569401445800_100283704_n

https://rojosonmedicalclinic.wordpress.com/2013/09/02/health-process-evidence-based-clinical-practice-guidelines-2013-09-01/

https://rojosonommcsurgeryfilesandnotes.wordpress.com/2015/08/24/development-of-a-health-process-evidence-based-clinical-practice-guidelines-model-in-a-clinical-department-in-the-philippines/

Here is an important read on the practice guidelines:

https://rojosonwritingsonhospitaladministration.wordpress.com/2016/04/23/management-of-a-patient-process-clinical-practice-guidelines-and-pathways/


ROJ@19mar18

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