Understanding what your doctor means when they say, “Standard of care”, and “I follow the guidelines”.

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If your doctor tells you they are following the standard of care you should let them know you understand that is the minimum they can do.

Doctor lingo is often confusing to those patients who don’t work in the medical profession, and even to some of us who work in medicine, so I believe it is important to translate some of the phrases your doctor uses when explaining why he or she has chosen a particular treatment plan for you.  This Blog addresses what your doctor means when he chooses a treatment plan based on the Standard of Care or the Guidelines written by his particular specialty group. These two terms are often misleading and often following guidelines or Standard of Care is an excuse for doing less than excellent care or even out of date care! Read on to understand how to interpret these phrases when choosing the best medical treatments for you or your family.

Over 25 years ago I decided to offer my help to patients who were injured and to doctors who were being sued without merit, by becoming an expert witness.  My husband is an attorney and I had always gotten many requests to review medical records for his attorney friends to determine whether a doctor had treated a patient with neglect or had injured a patient secondary to an act of malpractice.  Before engaging in this endeavor, I sat down with my husband and asked some necessary questions about what a patient could sue over and what a doctor could use to defend herself if she were sued without merit.

He taught me that doctors are held to a standard that is called the “standard of care” and if he or she fell below that level of care then she (let’s call all doctors “she” for this blog since I am a woman doctor) would be held negligent if there was lasting damage to a patient.  To my surprise he defined the medical standard of care as the lowest level of care or the least a doctor could do when caring for a patient. Prior to this time, I had thought “standard of care” meant the best care a doctor or nurse can give a patient; however, the name is misleading and is meant to protect doctors from lawsuits and to defend doctors working in indigent and rural areas where they have very few tools and tests to use to diagnose and treat patients. Needless to say, that day I changed how I used the term “the standard of care!”, and how I viewed the care I gave to my patients.

When planning a procedure or a treatment, If your doctor tells you he is following the standard of care you should let her know that you understand that that is the minimum she can do, and that you want the best care possible for your problem, if it is available the most accurate testing and treatment possible.  By letting them know, that you KNOW, you understand the lingo they are using and that you want to receive the best care, you are likely to have a much better outcome than if the bare minimum is done for you.

An example is often seen in the emergency room when a female patient comes in with urinary symptoms: painful urination, trouble passing urine, and back pain. The standard of care is to get a urine specimen and if there is blood in the urine, and white blood cells the standard of care would be to send the urine off for culture and treat the patient with antibiotics.  However, these symptoms are often the sign of a kidney stone, or a renal tumor.  A simple Xray can usually find kidney stones, or an ultrasound of the kidneys can diagnose dilation of the kidneys that would indicate an obstruction of the ureters like a stone or a tumor. Positive tests would lead to more diagnostic procedures and negative would solidify the diagnosis of a urinary tract infection.  The Xray and or Ultrasound would be above the standard of care, but not all hospitals have a radiologist on call to do these tests outside of normal business hours.  Another test that is above the standard of care is a culture of the cervix for chlamydia, a sexually transmitted disease that can scar fallopian tubes and cause infertility.  An above minimal care test would be to also culture the cervix for chlamydia so that the patient could be made aware of an STD so her partner can be treated as well as receive appropriate treatment for Chlamydia.  The chlamydia test would be above the standard of care but is also a necessary test in sexually active women to prevent infertility and should be done!

The term Standard of care is also the phrase used by politicians who want to cut your access to expensive treatments and diagnostic procedures.  When politicians who are supported by the wealthy insurance industry, or when political agencies like the CDC and NIH create a standard of care for all of America it is based on spending as little money as possible to serve the greatest number of people, NOT for the health and welfare of individual Americans. Beware when anyone including politicians, lawyers and doctors start using standard of care as a goal of treatment instead of the lowest common denominator of treatment.

You and I want the best care for ourselves and our family that our insurance, or Medicare will pay for and sometimes to get the best doctors or treatments we have to pay out of pocket as well, however the second misleading term that can cause us to be treated inferiorly is the “Medical Guidelines” of our medical specialty groups.

Let me tell a story about being board certified in a specialty such as mine, OBGYN. In 1999 the guidelines from the American College of OBGYN, ACOG, our national organization that sets treatment guidelines for doctors who care for women, gave a national re-certification test in Dallas, TX.  Hundreds of doctors sat in a large room and took a 6-hour written test that was supposed to test us to see if they were good enough doctors to be board certified in our specialty. All of the practicing OBGYNs had already been certified but a retest was necessary every 10 years at that time.  We all studied the guidelines that listed the tests necessary to provide the lowest standard of care to be a member of ACOG, but the problem was the guidelines were at least 10 years out of date, and if a doctor read the research and practiced the way we should, at the most advanced level of practice, then they would fail the test because it was behind the times!  For example, I had been treating PMS for women successfully for a decade with natural progesterone nightly during the second half of the menstrual cycle, and the research had come out that said it was a psychiatric disease, but in fact it was a REAL disease!  ACOG was so behind the times that they were wrong about the Diagnosis as a disease at all! On the test the question was, “Is PMS a real condition?”. The right answer for the test was NO, but the correct answer was YES!  The college of OBGYN was behind in its guidelines and teaching of residents by a decade! PMS had been acknowledged as a disease years before the test and those of us who practiced up to date medicine were marked wrong on this question as many others like it.  I was the victim of another outdated “guideline” that ACOG published in 1988 during my oral boards.  I was a few years out of residency when a 5 man panel of OBGYNs quizzed me about the surgeries I had done over the past year.  I had done quite a few ovarian cyst removals and ovarian removals through the laparoscope, which was the new (about 7 years old at the time) way to remove ovaries and cysts without making a big incision in a woman’s abdomen, and I had been taught in residency and continued to work with general surgeons to hone my skills with the laparoscope when I took this test.  I actually was failed because I was “ahead of my time” and used the laparoscope “too much”.  When I asked them how much was enough, they had no answer! The guidelines had not changed with the practice of my specialty! Now, most ovaries and ovarian cysts are treated that way!  Laparoscopic surgical technique had not been accepted into the guidelines yet, in 1988, but the research and practice had been around almost a decade!

Last but not least is the fact that there are always very old, retired and obstinate men at the top of the medical specialties who do not accept the new way of doing things until they are already being done by everyone!  If you are ahead of your time and treat patients with much more than the standard of care you are penalized!  I view the medical specialties a large leviathan that can’t turn quickly so is often behind the curve.

When trying to communicate with your doctor please ask for all the options available for your problem..not just medications but procedures too.  I had to see a cardiac physiologist because I have had atrial fibrillation for the last decade and it was getting worse. I finally needed a procedure to stop it, an ablation. II did my homework and knew there was a one-day procedure that did not require premedication with a poisonous drug that I am allergic to, so I knew it was possible to have this procedure with one day in the hospital and no premedication.  When I saw the first doctor, he told me I would have to be in the hospital on a drug (in the same family as the one I am allergic to) for 3 days ahead of time and 2-3 days after the procedure.  I asked him if there was any other way to do this, and he said no.  Then I knew he was lying!  I asked him if he did the procedure by using a balloon that froze the pulmonary vein in an hour or so, or a radio wave that took 5-7 hours under anesthesia. He told me the only way he did it was the radio wave because it was “safer”.  In fact, my extensive research revealed that the less time under anesthesia is the safest way for any procedure and that the balloon freezing method had fewer complications!  I left that doctor, never to return and interviewed another doctor who told me the truth and I am scheduled with him soon to have a one- day hospital stay with the balloon procedure.  When I asked him which he preferred to perform when ablating the pulmonary vein, he said he does both and I could choose which one I felt most comfortable with!  How refreshing.

So, the things I would like you to remember to protect yourself is that you don’t necessarily want a doctor who views the standard of care and medical specialty guidelines as the newest and best way to practice medicine.  I would also like you to ask your doctor these questions:

  1. Can you please compare the risks and benefits of the two or three types of treatment or surgeries for me?
  2. How many times have you done this surgery?
  3. How long will I be in the hospital, in recovery, out of work?
  4. Which medication or surgery choice would you have your mother, father, child undergo if they had the same problem as I do?

Run from a doctor who views the standard of care his highest goal and the guidelines to be current and the only way to practice!


This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author.   www.BioBalanceHealth.com  (314) 993-0963

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