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Standardised Care Does Not Guarantee a High Standard of Care

The “Standard of Care” is the term for the reasonable degree of care a medical profession is expected to provide a patient with a given condition and doctors in hospitals are expected to adhere to it.

Who sets the Standard of Care (SoC) for doctors to adhere to? It is written by The Standard of Care Board, a not-for-profit body made up of retired doctors, hospital administrators and medical researchers who were widely acknowledged as extremely accomplished during their career. They are tasked with looking at all the data to ascertain general principles which tend to work in most cases so these can be farmed out to hospitals for the information of doctors.

Just kidding – it’s Big Pharma.

The drug companies develop the SoC according to what they say they believe is the proper use of the drug – and there is nothing stopping them from doing it in whatever fashion they think will maximize their profit margins. The FDA endorses them with their approval process.

Insurance companies also have the power to influence the SoC and there is nothing stopping them from doing it in whatever way will maximize their profits. Insurance companies tell doctors that if they don’t adhere with the Standard of Care then the insurance company will not pay them. Private hospitals can also write the SoC, and they can write it according to what maximizes their profits. There is nothing stopping them from recommending expensive treatments with big margins when less expensive treatments with smaller margins will do the same job. Insurance companies won’t mind either, because they get a bigger kickback – sorry, I mean administration fee – for more expensive treatments than less expensive ones.

One group of people who definitely can’t write the SoC are doctors. The SoC is given to doctors through mailings, continuing medical education (CME) conferences and textbooks funded by pharmaceutical companies. Doctors are not free to override it, even in light of having better knowledge of the needs of their individual patients. If they make their own decisions based on their better judgement, they can lose the right to earn money working in hospitals, face malpractice suits – or even lose their license to practice medicine – even if judgement is sound and their decision-making is right.

Even in their own office, with the patient’s informed consent, they are not allowed to say, “Wait a minute, I was shown in a recent seminar that these medications can be dangerous for people in your condition. I would like to consult with the hospital administrators about an alternative treatment plan, and see if we can get the Standard of Care updated.”

In The Lethal Dose, Dr. Jessica Daniels tells the story of a patient who came to her in her mid-30s with Lupus. Daniels sent her to the specialist who recommended high doses of steroids with a taper. This was the standard treatment for lupus according to the SoC. Three months later the patient was dead – at around the age of 36! If she had done nothing, she would likely have still been alive. It was the medication that killed her. When Dr. Daniels called the specialist, he said it was “No problem” because they had followed The Standard of Care. She asked if they could try a different strategy next time and he said, “as long as we’re doing everything according to the Standard of Care, if patients die it’s not anything to worry about.” Nobody Investigated. No one tweaked the SoC or made exceptions. Even if the family of the victim had tried to sue, they wouldn’t have got a penny because malpractice is defined as “deviation from the Standard of Care.” In other words, malpractice law actually states that a doctor cannot be sued so long as he follows the SoC. However, if he refuses to prescribe a dose of a drug he knows would be dangerous to a specific patient he can be punished for it – even if it’s in the best interests of the patients. Even if the care provided causes death – even if the doctor knows in advance that the treatment provided will likely cause the patient’s death – he is safer following the SoC than his conscience! At least in this life.

What is the point of even having a doctor if they can’t exercise their own judgement and experience in light of knowledge on the ground? Is every patient the same? Does everyone with the same condition have the same needs? Why don’t we just program robots to do the job since that’s what we are essentially asking doctors to be. At this rate – no doubt, soon we will.

I am teaching an online course on the economics of healthcare reform beginning in January 2024! Please sign up below and get an early bird discount!

The Economics of Healthcare and Wellness – Focus on Transformative Solutions (ipak-edu.org)

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