Circulation 36,825 • Volume 18, No. 2 • Summer 2003

Standard of Care Should Be Based on Convincing Evidence

Samuel Metz, MD

To the Editor

Two exchanges appeared in the letters section of the Winter 2002-2003 issue, one regarding perioperative beta-blockade and another on ultrasound facilitation of jugular vein cannulation.1-4 They contained a common theme: when should we designate a practice as a Standard of Care?

A Standard of Care demands that all clinicians use the practice without exception. Failure or refusal to observe a Standard of Care due to lack of expertise, lack of money, lack of equipment, or personal preference will no longer be tolerated in quality assurance proceedings or a court of law. Violation becomes indefensible.

Once a practice becomes a Standard of Care, it can never again be tested for efficacy. A Human Subjects Committee would not approve a trial comparing the practice to a control group as controls would necessarily receive substandard care.

It would seem prudent to create a Standard of Care only when the evidence of patient benefit is so convincing that no further examination of the practice need ever be attempted.

Samuel Metz, MD
Philadelphia, PA

References

  1. Kleinman B. Perioperative beta-blockade requires further study—not Standard of Care. APSF Newsletter 2002-03;17:55.
  2. Shojania KG, Wachter RM, McDonald KM. AHRQ responds: promotes beta-blockade, encourages further study. APSF Newsletter 2002-03;17:55-6.
  3. Overdyk FJ. Ultrasound guidance should not be Standard of Care. APSF Newsletter 2002-03;17:56.
  4. LaPorta RF, Berger DB. Ultrasound guidance should not be Standard of Care. APSF Newsletter 2002-03;17:56.