Why docs must give up 'standard of care'

Emergency physician calls for doctors to follow "reasonable practice' instead
Tools

By Aine Cryts

Ceftriaxone, levofloxacin and piperacillin/tazobactam are three antibiotics for treating bacterial pneumonia. What's the right prescription for your patient? That decision depends on whether the patient is a child, an older adult with AIDS or someone who struggles daily with multiple co-morbidities, according to a recent commentary in Emergency Physicians Monthly.

Taking issue with the term "standard of care," William Sullivan, D.O., senior editor of the magazine and an Illinois emergency physician, advocates instead for doctors to practice "reasonableness" to inform medical decision-making.

"It's easy to allege that a practitioner failed to meet the 'standard of care,' but in doing so, we have to consider the meaning behind those words. A standard is a 'model' or 'example' to be emulated. But there simply aren't many 'standards' in medicine," he writes.

Because every patient is different, Sullivan argues that doctors judge medical treatments by their "reasonableness." For example, there's more than one acceptable way to manage a patient suffering from a heart attack, he writes. Whether the patient should be given aspirin depends on a number of factors, such an aspirin allergy or if the patient received aspirin six hours before the attack or in the ambulance on the way to the hospital.

Thus, any expert who testifies that there's a single "standard of care" in the use of aspirin to treat a heart attack is "untruthful" or "incredibly naïve," according to the commentary. That's because one single treatment regime avoids consideration of a patient's "unique body, mind and soul."

To learn more:
- read the commentary

Related Articles:
Evidence vs. opinion: The medical decision-making debate continues
Use shared decision-making to fight superbugs
Tool shows promise in curbing antibiotic overprescribing
How to make patients antibiotic stewards
Physicians, non-physicians provide similar heart care quality