Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Path: utzoo!mnetor!seismo!rutgers!clyde!cbatt!ihnp4!ethos!gary From: gary@ethos.UUCP (Gary J. Smith) Newsgroups: sci.med Subject: Re: The subject appears to be ME. Message-ID: <879@ethos.UUCP> Date: Sun, 2-Nov-86 10:01:09 EST Article-I.D.: ethos.879 Posted: Sun Nov 2 10:01:09 1986 Date-Received: Tue, 4-Nov-86 01:36:12 EST References: <525@aecom.UUCP> <2150@mtuxo.UUCP> Sender: news@ethos.UUCP Reply-To: gary@ethos.UUCP (Gary J. Smith, M.D.) Distribution: na Organization: Humanities Forum at ethos, Durham, NC Lines: 43 In article <2150@mtuxo.UUCP> wjc@mtuxo.UUCP (w.cambre) writes: >... the AMA is too tightly coupled with the legal system. When a doctor >goes on trial for malpractice, her guilt is determined not by what is right >and what is wrong, but rather by what is 'standard practice'. And the >AMA's guidelines are often what is considered standard practice. So if >you don't follow the guidelines, you are more apt to be sued and to lose, >right or wrong. The trouble with your comments is that you assume that it is easy to judge a universal "right and wrong" in medical practice. It simply isn't so. Another thing any medical student worth her salt learns is that "No two cases are alike." In a discipline that draws heavily on scientific generalizations and probabilities, this is a particularly troubling (but true) maxim. So even in the best of all worlds, medical "right and wrong" is never a clear "black and white" judgment. We do not live in the best of all possible worlds. The standards of practice must be different depending on where the patient lives, and the availability of medical resources in his geographical area. The standard of care for a patient in Alakanak, Alaska, (where there is no full-time physician) is going to be different than the standard of care in New York City. It is for this reason that the courts have rightly judged malpractice suits on the basis of the standard of medical care in the patient's local community. I have never been fond of the AMA, mainly because my politics are vastly different than the AMA's. But I have never thought of the AMA as setting forth guidelines for the standards of medical practice. That is a much more subtle thing--standards develop from articles published in medical journals (NEJM, Lancet, or sometimes JAMA) which slowly work their way into textbooks and medical school curriculum. The AMA is not a conspiracy to hamper the progress of medicine. The AMA is just a collection of old-boy physicians with less than an imaginative view of their profession. -- Gary J. Smith {ihnp4,mcnc,duke}!ethos!gary 919/493-9575 5802 Garrett, Durham, North Carolina 27707