What is the Standard of Care?

What is the “Standard of Care,” and why should you want to know about it?

by Adam Alban, Ph.D., J.D.

What is “the standard of care?”  Do you know?  Odds are, even if you’ve never heard the term, you’ve found yourself wondering about it.  If you’ve ever asked yourself, “what is the right thing for psychologists to do when ________?”, you’ve asked about the standard of care.  The standard of care is the answer to most of the “should” questions in our profession.

“How should we handle emails from patients?”

“How should children be interviewed?”

“Which norms should be used?”

“Should I see the cousin of a patient?”

The answer to all of these is that, no matter what you decide to do, you must at least meet the standard of care.  This begs the question, “what is the ‘standard of care?’”

The standard of care is a legal concept that is used to evaluate whether a professional’s activities meets the “standard.”  In a nutshell, if the things you are doing are as good as the standard of care, you are doing just fine.  As you might guess, there are standards of care for just about everything.  There are standards of care (thresholds of professional conduct) for recordkeeping confidentiality, etc.  Almost everything.

To put it bluntly, the standard of care is what most reasonable psychologists under similar circumstances do.  If you do what most of your colleagues do, you are meeting the standard of care.  Note that this isn’t want most of your colleagues think they should do, or what an expert has identified as a “best practice.”  It’s not an aspirational standard.  The standard of care is what most of your colleagues are actually doing.

Naturally, there are advantages and disadvantages to such an approach, but all things considered, the metric of “what a reasonable psychologist under similar circumstances would do” is a fairly good benchmark for what you should be doing.

A significant problem, however, is that many of our colleagues who are trying to be helpful don’t articulate the difference between the standard of care and “best practices.”  Experts offer opinions on all sorts of things, particularly on matters of professional conduct and ethics, without specifying that they are articulating (what they believe to be) an optimal approach.  This is unfortunate because when we conflate “the standard of care” with “best practices,” the perception can become the reality.  It’s important to state the difference.

An example might help to illustrate the point.  Suppose I offer the following (hypothetical) ethics opinion:

“Any psychologist that offers an ethics or professional standards opinion, without articulating whether a difference exists between his/her proffered opinion and the standard of care, may be acting unethically.  The failure to articulate whether a difference exists potentially violates several provisions of the APA ethics code.  Because a “best practice” might be misconstrued as a “standard of care,” § 1.01 requires experts offering opinions to take steps to mitigate this risk.  Ethics experts that fail to articulate this difference because they are not aware of this difference are potentially acting outside the scope of their expertise, and thus may also be in violation of § 2.01, which requires psychologists to act within the boundaries of competence.  Similarly, psychologists that offer an opinion on the standard of care or a best practice must state the basis for such an opinion.  Section 9.01 of the Ethics Code requires that psychologists substantiate their opinions/findings; any ethics expert who articulates an opinion on a standard of care is required to substantiate such a finding (i.e., how does he/she know what most reasonable psychologists in similar circumstances are doing).  Failure to abide by these sections of the ethics codes when offering an opinion on ethics may, inandof itself, be a violation of the ethics code.”

Careful readers will note a certain irony, which is that my hypothetical ethics opinion suffers from the very problem this article addresses: it fails to appreciate the difference between a “best practice” and the “standard of care.”  I might personally believe that all ethics experts should articulate this very important difference between “best practices” and “the standard of care,” and that failure to do so is an egregious error.  But if most reasonable psychologists in similar circumstances (i.e., ethics experts) fail to make the distinction(s) that I wish they would make, then by definition my opinion on what constitutes the standard of care for ethics experts is inaccurate.  Citing to the ethics code doesn’t change the fact that if very few psychologists do what I think they should do, then my assessment of the standard of care is just plain wrong.  I should have labeled my “ethics” opinion as a tip for “best practice,” or even an aspirational wish.

So let’s be careful out there.  Remember to be aware of the standard of care and to not mistake a “best practice” for the minimal bar of competence.

(CLICK HERE FOR PART 2 OF THIS ARTICLE)

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