I love acute-care medicine.  To the non-physicians in the audience, that means caring for people who call in sick today. This is in contrast to health-maintenance care where someone is being seen for diabetes, heart disease, hypothyroidism, and other chronic medical conditions. What’s the reason? Health-maintenance issues are far more regulated by “standards of care.”

These standards of care are issued by those who practice medicine from the “ivory towers” so-to-speak. As physicians, they are much less involved in actual patient care. They do their research and present their ideas at conferences where physicians are trained. For example, they would recommend that diabetics check their blood sugars 4-6 times per day.  This in itself is not a bad idea, but in the real world, you are lucky if you can get them to check it once a week. The most disturbing issue is that I am the one being held responsible for the patient’s non-compliance.

Physicians who monitor these issues from the certification and licensing departments and lawyers who try to recover monies for the often-deceased patient’s family, see the physician as the bad guy rather than holding the actual patient responsible for their own care. As in most of these cases, it is not out of ignorace that non-compliance occurs. And, it’s unrealistic for me to run around after the patient all day and demand that they check their blood sugar after that Big Mac they just ate. 

So in the real world, we just do the best we can. We encourage the patient to do a better job, we maintain an amicable relationship with the patient to foster trust when we are really needed, and we ignore the “standards of care.”  Please remember this if you are ever on the jury when the physician is being sued.