Defining the Standard of Care

Written by 
PRMS
 

Q.  I know my patient care must always meet the standard of care, but how exactly is the standard of care defined and determined?

A.  The exact definition of standard of care varies by state, but generally, it is the degree of skill, care, and diligence exercised by members of the same profession or specialty practicing in light of the present state of medical science.  It is important to keep in mind that the standard of care does not mean optimal care, but includes a range of acceptable treatment options.

There are many factors that could be used asevidence of the applicable standard of care for a particular patient care issue.  These factors that determine the applicable standard of care include, but are not limited to, the following:

  • federal and state statutes – such as federal and state prescribing laws
  • federal and state regulations – such as regulations from your state medical board, the Food and Drug Administration, and the Drug Enforcement Agency
  • case law – federal and state
  • other statements from federal and state regulatory agencies – such as guidance documents or policy statements from your state medical board
    • authoritative clinical guidelines – such as the American Psychiatric Association’s practice guidelines
  • policies and guidelines from professional organizations – such as the PhysiciansMedGuide,a joint statement by the American Psychiatric Association  and the American Academy of Child and Adolescent Psychiatry, which addresses the treatment of children with depression
  • treatises
  • journal articles
  • accreditation standards – such as Joint Commission standards
  • a facility’s own policies and procedures
  • Physicians’ Desk Reference

In psychiatric malpractice litigation, the standard of care is established primarily by psychiatrists in the role of the expert witness.  The expert witness will base his/her opinions on the items mentioned above evidencing the applicable standard of care, his/her own clinical experience and education, and the clinical record.  Accordingly, the psychiatrist’s documentation should support the care that was given and should enable someone else – such as an expert witness – to read the record and know what happened and why.  One way to accomplish this is to document not only what happened in treatment and why, but also what actions were considered but rejected and why.

PRMS
Manager of The Psychiatrists’ Program
Medical Professional Liability Insurance for Psychiatrists
1-800-245-3333
Twitter: @PsychProgram