How Standard Is “Standard of Care”?

Chicago— How much do your treatments and procedures vary from the established standard of care? Does it matter?

The Triological Society panel on “The Elusive Standard of Care,” addressed these questions here at the 2006 Combined Otolaryngology Spring Meetings (COSM). The panel, moderated by Mark S. Persky, MD, Chair of Otolaryngology–Head and Neck Surgery at Beth Israel Medical Center in New York City, provided an opportunity to review how four established otolaryngologists would approach the same patient.

No one on the panel uses facial nerve monitoring regularly during procedures, but the audience was in favor of it.

Panelists included Daniel Descher, MD, Director of the Norman Knight Hyperbaric Medicine Center at the Massachusetts Eye and Ear Infirmary in Boston; Paul Donald, MD, Professor and Vice Chairman of Otolaryngology–Head and Neck Surgery and Director of the Center for Skull Base Surgery at the University of California-Davis; Gady Har-El, MD, Professor of Otolaryngology and Neurosurgery at State University of New York-Downstate in Brooklyn; and Richard Smith, MD, Associate Professor of Clinical Otorhinolaryngology–Head and Neck Surgery at Albert Einstein College of Medicine in the Bronx, NY.

Dr. Persky began by providing a definition of standard of care, stating that it commonly accepted as “How similarly qualified practitioners manage a patient’s care under the same or similar circumstances.” However, he asked, “Could there be different standards of care?” Different physicians may be influenced by their personal experience or training, the medical community in which they practice, and the resources available to them.

Dr. Persky set out to vividly demonstrate possible differences in standards of care by asking the panel for their opinions on a specific case study. The case involved a 32-year-old woman with a two-year history of a slowly enlarging, two-centimeter, painless parotid mass. The woman’s cranial nerve (CN) VII was intact with no enlarged nodes.

Standards for Evaluation and Pre-Operative Tests

“How would you evaluate the patient?” Dr. Persky asked the panel. Dr. Donald spoke first, saying “I’d take her history and do a complete head and neck physical exam. Next, I’d ask for imaging. A CT scan or MRI is expensive, and they can add additional information—or not. Cytology is of some value, but it’s limited. I’d include cytology, and judge whether to do a CT scan on an individual case.”

Different physicians may be influenced by their personal experience or training, the medical community in which they practice, and the resources available to them.