Magazine article Medical Economics

Q&A: Are Rural Doctors Held to Big-City Standards?

Magazine article Medical Economics

Q&A: Are Rural Doctors Held to Big-City Standards?

Article excerpt


I'm a primary care physician in a rural area that doesn't have nearly enough specialists or the latest equipment and technology. It seems unfair to hold rural physicians to the ivory-tower protocols and expectations that might apply to urban doctors, who have specialists and MRIs on every corner. Is there a national standard of care?


A generation ago, physicians were held accountable to the standard of care of doctors practicing in their own community. Now, with the wide dissemination of medical information and growth of national specialty programs, the "locality rule" has largely given way to what a "reasonable" physician in the same specialty would do in a similar circumstance, regardless of where the care was provided. Thus an internist in rural Kansas may be expected to meet the same basic standard of care as a colleague in Boston. A plaintiff may call an expert witness from anywhere in the country to testify about whether the standard was met.

Even so, most juries will take into account the fact that specialized facilities, tests, procedures, and physicians aren't always available in remote areas. It's simply unreasonable to expect a small rural hospital to offer the same services and sophisticated level of care as a major medical center in a large city. Doctors are required to use their best judgment with the resources available to them, however.

Jurors often forgive honest mistakes and support a local physician who can document that he did his best with the available resources. It's up to your defense attorney and witnesses to present a more reasonable standard, and to point out that day-to-day medicine practiced by physicians in your community isn't the same as that in academic settings.

You can help yourself in this situation, though. Even if the patient won't travel to see a specialist, you might consult with one yourself, just to get a better handle on the clinical situation. …

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