o.d. to o.d.

What is the “Standard of Care?”

First off, it’s not a medical term. Perhaps it’s time to replace this phrase.

BY SCOT MORRIS, O.D., F.A.A.O. Chief Optometric Editor

In putting together our Medical Services issue, I’ve thought a lot about the definition of “standard of care.” I hear it at CE events, various roundtable discussions, and I see it in articles, but what does it mean?

My research revealed that “standard of care” is actually not a medical term. It’s a term defined by tort law as, “the degree of prudence and caution required of an individual who is under a duty of care. Usually, it is determined by the standard that would be applied by a reasonably sensible person in that specific occupation at a level that person with similar training and experience in a similar community would practice under the same or similar circumstances.”

This definition poses more questions than answers.

“Determined by the standard…”

Many practitioners define “standard” as scientifically proven methods. Most research examines a limited scope of specific disease modalities. From there, a limited number of treatment options are assigned to the specific disease state to prove their effectiveness, many times without taking into account other modifying factors. Obviously, all the options are not pursued, because it is too expensive to look at every disease state.

My point: Many times, clinical experience and stepping out of the proverbial “standard of care” treatment box may prove just as advantageous as using scientifically proven methods. Don’t get me wrong. I think evidence-based medicine is essential, but we are a long way from having the algorithms or a mass quantity of data to truly make clinical decisions from evidence-based medicine.

“Standard” is often defined as “average.”

Something else to consider: “Standard” is often defined as “average.” If everyone is performing at an average level and that level, though the standard of care, is inferior to a “less proven” method, is it really best for patients? Do patients hope for average care?

“Reasonably sensible person…”

What constitutes “a reasonably sensible person?” Some of the most important breakthroughs have come from those a “little on the edge” and willing to step outside the normative thinking of the time.

“Similar training or experience…”

We don’t possess the same training or experience. I am undoubtedly as well educated and more experienced in certain disease states (i.e. ocular surface disease) vs. some of my peers and also significantly less educated and experienced about certain conditions (i.e. binocular vision disorders) vs. many of my peers. (See the cover story, “Is it Time CE Changed?,” page 16.)

What does it really mean?

After lots of research and thinking, I still don’t know what “standard of care” means. It poses a lot of questions, though. So, instead of using this phrase, let’s replace it with “clinical practice guidelines,” with the understanding that we should try to expand upon these guidelines in a safe way. Let me know your thoughts. OM