This week's problem is addressed by Herb Alexander, MD. A prominent orthopaedic surgeon, Dr. Alexander is a retired United States Navy Captain and has held numerous leadership roles throughout his distinguished Navy career and in private practice. Dr. Alexander remains active academically, lecturing nationally and internationally, and is a Founder and Principal of MDReview.
Problem:
"Members of our medical staff are not clear on what definition 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 proof reading 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.
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