Perspective: What is a “prudent and reasonable physician”?

March, 2012

[Editor’s Note: This month’s “Perspective” comes from Mark Plaster MD, Editor of Emergency Physicians Monthly. It was first published December 5, 2011, and is edited for brevity.]

It seems such a simple question: Given a specific set of facts concerning the presentation of a patient in the ED, what would the prudent and reasonable physician do?

This is the “standard of care” against which a physician’s actions will be judged in a case of alleged negligence. Each state has their own set of jury instructions that defines the standard of care. Most say something like Connecticut’s, where “the standard is that level of care, skill and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers.”

The question then is what is “acceptable and appropriate” to a “reasonably prudent” emergency physician?

Emergency physicians seem to have a hard time with this simple standard. Where they have problems is that they do not want to accept that many reasonable and prudent courses of action can have bad outcomes. They assume that any course that could have been taken to avoid the bad outcome should have been taken. They assume that, being the smart and reasonable doctors that they are, they would have foreseen the untoward outcome and taken the higher road to the right answer. Thus, even if only 5% of the physicians would actually have taken this course of action, that course would be the standard of care.

This, of course, is illogical.

There remains a lot of room between best practices and negligence. Emergency physicians do themselves a disservice – and misinform our patients and the courts – to suggest that anything other than the currently held best practices is negligent. When best practices are first promulgated they are hotly debated – as they should be. Eventually they become accepted, but that is a process, not an event. There are still early and late adopters, and each clinician has his own reasons for being one or the other.

While it is true that the best practice eventually becomes the standard of practice, we should be wary of labeling everyone who adopts later than me, negligent.

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