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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:

  1. 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.
  2. 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".
  3. 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".
  4. 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.
  5. 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.
  6. 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".
  7. 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)