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Types of
Medical Standards of Care
Professionalism has to do with high mindedness of
attitude in effecting standards of care and in relational skills leading to favorable care of
patients. Having been frustrated by the very discouraging way that the USA legal system
dramatizes "standard of care"; and, having seen almost all accrediting agencies focus on
legal approaches to "standard of care"; and, yet knowing that the issue was much more
complex: I was greatly appreciative of the exposition of such in the "Piece of My Mind" page
of the 1 May 1996 issue of the Journal of the American Medical Association by Odysseus Argy,
M.D., of South Dartmouth, Mass., USA. (JAMA 275 (17):1296; 1996). He notes that there are
actually SEVEN standards of care for each move in the medical
arena:
- IDEALIZED STANDARD OF CARE:
This is what a good doctor would do with a patient if there was unlimited time and
resources, and no distractions from other patients or other aspects of the doctors
life.
- ACADEMIC STANDARD OF CARE:
This is a highly structured approach requiring precise documentation of scientific
evidence for and against all possible diagnoses. Even highly skilled use of judgment and
probability must be supported by "evidence". This approach tends to view the patient as a
"case" rather than a "person".
- PRACTICAL STANDARD OF CARE:
This is the care good doctors apply given the limitations imposed by area resources,
personal stamina, and the limitations of such as "managed care
programs".
- MEDICO-LEGAL STANDARD OF
CARE: This is the level of care doctors feel that they must give in order to
protect themselves from possible malpractice lawsuits.
- ECONOMIC STANDARD OF CARE:
This deals with costs and charges. It includes games which must be played with 3rd party
payer rules about charges. And it deals with such things as conflicts over the choice and
preference of a more expensive drug, treatment, or diagnostic study when agencies or
others contend that less expensive alternatives would have done just as
well.
- MANAGED CARE STANDARD OF
CARE: This is not similar to the economic standard of care. This has to do with
a wide variety of decisions and contesting as the managed care businesses try to
manipulate costs in order to create cost savings which can then translate into company
profits. Patients are seen as actual "commodities" (commodities being things such as pork
bellies, coal, oil, gold) called "covered lives".
- PERSONAL
STANDARD OF CARE: It is an incorporation of all of the above in some unique mix
which results in what each individual physician wants to do and is able to do most of
the time. It is influenced by variations in training and education. A doctor who was an Eagle
Scout might vary from one having an early teenage period as a gang member. A practicing
Christian might vary from an atheist in some basic approaches to patients. The individual
physicians moral, ethical, and humanistic code of conduct has much to do with his/her selection
of "the right thing to do". At the local "point of care", you should select a doctor firstly
according to what you can find out about his/her "personal standard of care". One matching your
criteria is likely to also develop referral links to specialists of similar
inclination...especially when your personal doctor has any idea that it will make a difference
in your experience.
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(posted 17 August 1999; latest addition 21 May
2005)
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