The Importance of Disclaimers: Distinction Between Optimal Care and Standard of Care

Abstract

To the Editor .— As a practicing pediatrician who occasionally does medical expert witness work and a malpractice defense attorney, we applaud the carefully worded and prominent disclaimer found in the clinical practice guideline published recently in Pediatrics by the American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis.1 The subcommittee states: “This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis.”1 Previous guidelines and “best practices” have not always been so carefully worded. The lay public, practicing physicians, academics, the press, and the legal profession have all been guilty, at times, of blurring the important distinction between optimal care and standard of care. Lack of attention to this kind of detail all too often leads to misunderstandings and the initiation of malpractice actions. “Optimal care,” although always the goal of medical …