What is Standard of Care?

What is Informed Consent?
May 4, 2009
Blood in a Baby's Eye
May 6, 2009
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What is Standard of Care?

Standard of care establishes how doctors choose which treatment is most appropriate in a given situation.

Believe it or not, doctors are highly regulated.  Insurance companies tell us what and how much we can charge, government tells us everything from patient confidentiality to how to clean our dishwashers and we (with the help of lawyers) regulate ourselves by following the “standard of care.”

The standard of care is the preferred treatment that any other  prudent health care provider (prudent is a key legal term), given similar backgrounds and training, would choose in the same situation and in the same community.  That is, if Dr. Wong is prescribing a treatment for Patient X who is sick, then Dr. Jones who practices locally, if following the standard of care for the same diagnosis, would be offering the same treatment.

Doctors don’t like when complications occur.  Complications may occur with the disease or with the chosen treatment, be it medicine or surgery.  A complication is the unfavorable outcome of a disease or procedure.  Patients don’t like complications either, but some lawyers love them.  Complications can sometimes grow into law suits.

Basically, if a complication occurs and a law suit follows, it is important to see if mistakes were made by determining if the health care provider proper informed consent (see yesterday’s post) and if he followed the proper standard of care.  It is easier to defend doctor’s if these two elements have been fulfilled.  If a doctor chose to deviate from the standard of care and a complication followed, then watch out.

Lastly, standard of care also has another implication.  It allows us to use treatments that are so-called “off label.”  A good example is an FDA (Food and Drug Administration) approved medicine.  Usually, a pharmaceutical company will invent a new drug and spend lots of money and time developing it and then testing it to make sure it works and is safe.  The FDA will review the testing and approve it based on the data.  The drug will also be approved for use in certain conditions.  Doctors may establish a different or “off-label” use for the drug, yet it is okay if that is the standard of care.

A great example is the drug Avastin ® (bevacizumab) which is FDA approved for treating colon cancer and lung cancer.  It is not FDA approved for treating macular degeneration.  Most retina specialists, at least in my area, use Avastin for treating macular degeneration.  It is okay to use as it is the standard of care.

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Comments
  • SHAUN HILL June 16, 2011 at 10:58 am

    What is standard of care with today’s modern advances in retinal surgery for macula-off retinal detachment ? I was taught this is an ocular emergency, but our retinal docs say 48 hr being seen is standard of care. They quote a study from 2003 stating that there was no difference in outcome from 1-2 days,2-3 days, 4-5 days, and 6-7 days after macula off presentation.

    • Randall V. Wong, M.D. June 20, 2011 at 10:09 am

      Dear Shaun,

      A retinal detachment including the macula (already detached) should be repaired within two weeks for best prognosis. I am in agreement with your retina docs’ opinion. In most locales, however, it is treated as an emergency usually for the sake of competition.

      A retinal detachment where the macula is still attached, should be operated on timely to prevent it from detaching.

      Thanks.

      Randy

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