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