Although most patients don't know it, 21 U.S. states follow some form of an 1880 ruling that says the standard of care physicians must meet by law depends on where the doctor practices, even if, in some cases, it is a small town with only two doctors.
That means what is considered malpractice in some states may be considered acceptable practice in others, say researchers at Georgetown University Medical Center and Johns Hopkins Berman Institute of Bioethics.
This "Locality rule" can negatively impact both physicians and patients, and should be changed to the national, evidence-based standards of care that the 29 other states and the District of Columbia have now adopted as the basis for malpractice law, the researchers say in the June 20 issue of the Journal of the American Medical Association (JAMA).
"Whereas this rule protected rural physicians in the 1800s who didn't have access to the kind of medicine available in larger cities, it now works to create uncertainty for physicians, especially those who practice in more than one legal jurisdiction, which can translate to less than adequate patient care," says the study's lead author, Michelle Huckaby Lewis, M.D., J.D., a Greenwall Fellow at Johns Hopkins University and Georgetown University.
"We now live in an age where all physicians have the same opportunities to stay current, at least as far as medical education is concerned, so the standards by which physicians should be measured should be the same throughout the country and must not depend on where the physicians practice," she says.
The authors suggest that in states where medical resources are an issue, a resource-based national standard of care can be adopted, as some states have done. For example, some advanced screening technologies used in many states may simply not be available in others, so a resource-based standard would take that into account, they say.
"This issue hurts patients who may want a cutting edge treatment and physicians who want to practice evidenced-based medicine, and not be limited by what other doctors in their communities are doing, " says the study's senior author, Dan Merenstein, M.D., assistant professor in the Department of Family Medicine at Georgetown University Medical Center.
"Let's say there is a new drug that has been proven in many studies and has been endorsed by expert groups as the best to treat Parkinson's disease," he says. "Well, if I am seeing a patient in Maryland on Monday I should be comfortable using this medicine as this state uses national standards. But if I am treating a patient on Wednesday in Virginia, which uses locality rule, I may need to think twice, especially if I sense that most doctors in Virginia don't yet use the drug.