Legal Uses

Standard of Care is also used in legal settings as a way of identifying medical malpractice, or negligence. The standard of care is often used as the benchmark against what actually occurred during an episode of care--when referencing the doctor’s actual work, for instance.

 

Malpractice, or negligence, means not exercising reasonable care when treating the patient, or doing something wrong. In legal terms, this is based on the “reasonable person” standard. If a reasonable person would provide the patient’s care a certain way, then not providing the care that way could be considered negligent. And if a reasonable person would have done a particular action, then not doing that action could be considered negligent. Another way to think of this is the standard of care means as compared to the average physician and their customary practices in a given situation, how does that compare to what the physician in question has done?

 

To prove medical malpractice, the patient’s lawyer would want to demonstrate how the doctor did not follow the accepted standard of care for the patient’s condition. Conversely, the doctor’s lawyer would want to show how the doctor’s care did follow the standard of care for the patient’s condition.

Standard of care used to identify medical malpractice or negligence Malpractice or negligence compared to “reasonable care” SOC evolve over time and may vary between areas SOC expectations apply regardless of payment for services

 

In a legal setting the standard of care is provided by expert witness testimony. The physician only has to show that he provided the level of care that a minimally competent physician would have provided in the same situation and given the same resources. The physician doesn’t have to show that he exceeded the standard of care’s guidelines, only that he at least provided care commensurate with them. And it is important to keep in mind that as these standards of care evolve over time (with new research, therapies, technologies or medications), and that they may still differ slightly from one area to another (mainly because of different resources being available), searching for a legal precedent in a malpractice case as a way of proving guilt oftentimes will not clearly apply.

 

There are clear examples for medical standards of care aside from the example just discussed. For instance, the recipient of pro bono (free) medical services is entitled to expect the same standard of care as a person who pays for the same services, which prevents an indigent person from being entitled to, and receiving, only substandard care. Also, a physician has a “duty to inform” a patient of any financial interests they might have in a medical treatment or facility which could influence their decision to undergo a procedure or treatment regimen.

Standard of care provided by expert witness testimony Physician only needs to show that he did what a minimally competent physician would do Does not need to exceed standard of care guidelines Pro bono care needs to meet the standard of care

Ethical Issues

Standards of care also refer to integrity; a moral and ethical code. The physician’s primary ethical obligation is to protect and promote the well-being of their patients. Sometimes, as an example, this means persuading a patient to pay out of pocket (using their health savings account or wallet) to enable them to receive appropriate care for a set of symptoms. As, for instance, the standard of care for suspected cholecystitis (gallstones) is to confirm with an ultrasound, which may seem redundant and unnecessary in a patient who has a confirmed history of the condition. At other times it may mean recognizing that their patient’s preferences and values include considerations other than just medical; not just what a particular treatment is going to cost them, but maybe the timing of a particular clinical intervention, the location where it might occur, or something else. When the physician or other healthcare provider recognizes these concerns they are strengthening their relationship with the patient. It helps to show the patient that they are considered as more than a subset of their symptoms--and that they will be treated as individuals.

 

SOC also refers to integrity to promote and protect patient well-being.

 

These examples help to illustrate the four guiding principles of medical ethics as they apply to standards of care:

Beneficence – a healthcare provider should act in the best interest of the patient.

Autonomy – the healthcare provider(s) must recognize that the patient has the right to refuse or choose their treatment.

Non-maleficence – the healthcare provider should not be the cause of harm.

Justice – as concerns the distribution of scarce health resources, the healthcare provider must make appropriate decisions as to who gets what treatment (fairness and equality).