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STANDARDS
of MEDICAL CARE |
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A most important and ubiquitous legal practice is that of defining
"standards of medical or health care care." At one
time such standards were referred to as the "standard of care in the community"
but, with the globalization of information and credentialing,
standards are now considered to be national (and probably will be
global in the future) and not
just simply related to the community. There are however
special circumstances, as when a community is physically isolated
from the rest of a country, that national standards might not
apply.
"Standards" can be primary or secondary. An
example of a primary standard is that of informed
consent which requires complete disclosure of risk. A
secondary standard, which assumes that the primary standard has
been met, may relate to the treatment itself.
An interesting situation exists when a common practice is inherently
unreasonable. In this circumstance common practice would not
be considered a "standard of care"? This would be
particularly so if the practice were to be based on misinformation
or ignorance.
Do examples of unreasonable practice exist today? Yes,
indeed they do. One of the most remarkable cases in point
has been the use of neurotoxic substances in steroid suspensions being
used in "epidural steroid" injections to treat low back
pain. Violation of primary standards, in such cases, is
widespread. Given that there are other, safer, alternatives
than neurotoxic substances for
use in this procedure the use of a neurotoxic agent can not be
considered legitimate since it represents only a aberration of
good practice.
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