Defining Standard of Care

Problem:

“Members of our medical staff are not clear on what definitions should be used for ‘the standard of care’. What definition does MDReview use?”

Solution:

Most commonly, “standard of care” is defined as the medical care that the vast majority of prudent providers would practice. It is how similarly qualified practitioners would have managed the patient’s care under the same or similar circumstances. As such, in the context of external peer review, the “standard of care” is defined by the expert reviewers we select to be members of the MDReview panel. It is what they would do or what they consider acceptable to do under the same or similar circumstances. This approach effectively accommodates the difficult or unusual circumstances often described as the rationale behind the care provided. Our reviewers do their best to put themselves in the shoes of the subject physician to determine if the care provided was or was not consistent with what they would have done and to what extent any deviation impacted the patient’s outcome.

Note that all conclusions reached by the reviewer must be explained and supported. Our project management team’s acute attention to detail and proofreading by an MDReview physician principal ensures, among other things, that solid support for the conclusion is provided. But just as with conflicting parties in a medical malpractice case, the standard is sometimes debated. There is the black, the white and the gray. Our reviewers and the conclusions they reach work to accommodate all three. Although more rare, any conclusion that falls into the gray area must also be explained and supported.

Some of our clients have tried to draw a distinction between “standard of practice” and “acceptable care” or “appropriate care”. We find descriptors such as “acceptable” or “appropriate” problematic for their subjective nature. We always conduct our reviews as if our clients are headed for fair hearing or court, even though that is unlikely. Sticking with widely-accepted terminology that is less open to interpretation is the best approach and is the rationale behind the language we have chosen for our standardized case conclusions.