I always enjoy speaking to and reading Dr. William Sullivan’s work and opinions in the field of medical legal issues. I think that he is truly a thought leader in emergency medicine. His February 2016 article in Emergency Physicians Monthly is very thought provoking.
In this article, he explores the use of the phrase “standard of care” and suggests that the term has been misused, misunderstood, and should be replaced with the phrase “reasonable practice.”
He relates a great example in this excerpt
Consider a patient suffering from an acute ST elevation myocardial infarction. While the “standard of care” may dictate that the patient receives aspirin (even though, with a NNT of 42 , it is clear that not everyone benefits from this intervention), the same “standard of care” would dictate that the patient NOT receive aspirin if the patient was aspirin-allergic, the same “standard of care” would dictate that the patient SHOULD receive aspirin if the same “allergy” was merely GI upset, the same “standard of care” would be that the patient NOT be given aspirin if the patient already received aspirin in the ambulance on the way to the hospital, and there probably wouldn’t be a “standard of care” at all regarding whether the patient should receive aspirin in the hospital if he took aspirin with his other morning medications 6 hours prior to symptom onset. An expert who testified that there is a single “standard of care” regarding aspirin administration in acute myocardial infarction is either being untruthful or is incredibly naïve.
- Lancet. 1988 Aug 13;2(8607):349-60. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.