Courts' views on MDs' standards of practice changing, rural docs warned
CMAJ 2000;162:1339
It appears that the longstanding legal practice of lowering the standard of practice to accommodate the limited facilities and resources available to Canada's rural physicians is becoming a thing of the past.
Recent US decisions indicate that, because of advances in communication technology and access to larger centres of education and science, the courts no longer automatically adjust the standard of practice downward according to a physician's practice location. Instead, said Niels Ortved, managing partner McCarthy Tétrault, a Toronto law firm specializing in medicolegal cases, "appropriate allowances" are being made.
"Historically, the locality rule was often relied upon to recognize the differences between urban and rural medical practices," Ortved told about 150 surgeons attending a recent medicolegal course at the University of Toronto. "However, the advantages of modern communication and education have reduced the disparities between rural and urban practices."
As a result, locality is merely one circumstance that is considered by the court in setting the standard of care imposed upon a physician when medical cases end up in court. He advises rural physicians to be "mindful of their access to information on tertiary care centres" and "be diligent to tap into these resources when appropriate."
In rural Manitoba, for example, a family physician was sued for failing to inform a patient about the side effect that a drug could have on her fetus. The doctor argued that his practice was in accordance with the standard of rural practitioners. The judge rejected his argument, saying that the doctor could have easily acquired more information.
In other words, said Ortved, "the court held that the doctor failed to conform with the basic standard of care to which all physicians must be held — regardless of the location of their practice — to make use of the tools available to them to obtain in a timely manner the facts and information on which to make an informed decision, which may include referring a patient to a tertiary care centre." — Barbara Sibbald, CMAJ
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