Challenges in Elucidating Ophthalmology's Standards of Care: A Review

Defining a standard of care is difficult, and physicians don't always agree on what it means in specific contexts. This is, in part, owing to constantly changing treatment patterns; but at the same time, the underlying framework that determines standards of care is continuously evolving. This situation presents clear challenges for all practicing physicians, including ophthalmologists.

Complicating the issue of defining a standard of care are the confusing origins and lexicon used to describe 3 related yet distinct ideas: standard of care, practice guidelines, and gold standards. Indeed, each of these terms is defined and influenced by many stakeholders both inside and outside the health care system. The term standard of care is one example that, although used frequently as a medical term, is often decided by courts and industry. Ophthalmology itself has provided one of the most influential cases in standard-of-care law history (Helling v Carey), which standardized the routine use of tonometry after the plaintiff lost vision because of a delayed glaucoma diagnosis. But even the courts' current view of standard of care is far different than it was at that defining moment in eye care history.

Today, health care professionals typically equate standard of care with best clinical practices, and yet the law specifies a standard of minimal competence when determining standard of care. These competing definitions are, at best, misleading and, at worst, counterproductive. This narrative review examines how medical guidelines are developed, formalized, communicated, and adopted in the United States. It seeks to clarify ophthalmologists' understanding of the related but distinct ideas of standard of care, practice guidelines, and gold standards. Last, this review argues that quality of care must be distinguished from standard of care and outlines how legal definitions of standards of care can set exceedingly low benchmarks, discouraging innovation without reducing frivolous litigation.