What Is the Standard of Care,

Anyway?

In practicality, as John Ecenbarger so adeptly rubbed in our face in his now infamous Reader's Digest article, the standard of care appears to be whatever level of care the public will stand for.

Of course, this is not the legal definition. The legal definition is:

The standard of care is the level at which the average , prudent provider in a given community would practice. If treatment for which a recognized specialty exists is in question, then the standard of care is defined by the level at which an average, prudent specialist would practice, even if the treating doctor is a generalist.

In his excellent book, Healthcare Marketing in Transition, (Irwin Professional Publishing, 1995, 1-800-634-3966), author Terrence J. Rynne has pegged the "true essence" of Standard of Care, and in a manner that clearly defines the paradigm under which today’s healthcare leadership has been functioning.

Healthcare Organizations are Expert Oriented

Healthcare organizations are classic examples of expert-driven organizations. Healthcare providers think they know their business. They know what’s good for the patient. They know what quality is. They know how to evaluate good from bad providers of healthcare. The marketplace doesn’t. Their skills and their high technology are what are important. One doesn’t listen to the marketplace, one "educates" it.

This cluster of beliefs keeps healthcare organizations from the surprises and successes that come from approaching the customer as the font of marketplace success. The marketing concept reverses the dictates of the expert-driven organization. "Quality is whatever the customer says it is. A good service is defined by the customer in a much broader way than the expert provider defines it. Quality services begin with the customer and their needs, not with the skills and technology of the provider."….

….it takes … great creativity and tenacity to work a cultural transformation in organizations that are as embedded in a reverse posture as are most healthcare organizations.

Therefore, regardless of any legality or levels of professionalism, it all boils down to the fact that the Standard of Care is whatever the public has been trained (from multiple sources) to accept, no matter how good or how bad.

Mr. Ecenbarger went looking for a profession that defined its own Standard of Care. He didn't find it. He reported that, and dentistry went haywire. A careful reader will try to find the opportunities for dentistry afforded by Mr. Ecenbarger's report.

Finding that we do not define the Standard of Care in our own profession may be disorienting. We may hide from it. We may denounce the concept. We may shoot the messenger. Yet the proof that Mr. Rynne's premise is true is all around us- the public has embrased reduced-fee health care despite obvious decreases in the nuances of care such as provider contact time, time spent waiting for appointments, ability to freely access a specialist, etc. These are inarguable decreases in the level of care, yet the public seems willing to accept the so-called "managed care horror stories" as long as it does't happen to them personally. People still say, "I had to change doctors because my old one wasn't on the plan". Welcome to the bottom line era.

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8American Independent Dentist's Association
Last update 11/29/97