My experience with this ‘concept’ began with my son’s birth thirty-six years ago, and to this day, managing his most difficult birth defects and health challenges. Additionally, my experiences include healthcare in five countries, surgeries in three, and before retirement, providing staff in England with private health insurance.
From this linked article - “The standard of care is a legal term, not a medical term”. “Note that the standard of care is not optimal care. Rather, it is a continuum, with barely acceptable care at one end, and the ultimate in care at the other end”:
I (try to) discuss with my American doctor’s the volume and contracting incentives and volume vs. value base care incentives in their respective practices:
I've tried, in vain, to explain the concept of SOC to members in the past that SOC is a legal term and will always be a legal term because of malpractice insurance and the legal system here in the US.
To drive down costs, we need fundamental change in the medical malpractice laws, i.e. less law suits
Medical malpractice lawsuits seem to have diminished considerably since their peak in the 80s/90s. That's my impression. Doctors' lobbies within states can be very powerful.
Some file frivolous lawsuits. Others believe no doctor or other medical provider (even drug companies) should ever be sued--just let the profession police itself. Those are the two extremes.
I honestly haven't seen that SOC has caused individual doctors from doing their thing. Even in PCa treatment, many doctors are doing their own mixes of surgery, radiation, ADT, chemo, etc. That's reflected on this forum.
Some states have better malpractice environments than others. TX is the best. Many have caps on damages for "pain and suffering". PA and NY are some of the worst states for doctors. Some patients, when told that they have no grounds to sue, then write a complaint to the state medical board. All of these complaints require and investigation by the state medical board. The physician then has to hire an attorney to draft a response. Most of these are frivolous yet require a response
I am not so much thinking in terms of cost and malpractice, but rather, where one's treatment path falls on the continuum of barely acceptable to ultimate in care, including medical recommendations based at least in part on volume and contracting incentives and volume vs. value based care incentives. I went to several "major centers" and IMO their recommendations did not even closely approach ultimate care.
I care, as it identifies to me the root cause of the medical disparities, including (sometimes spiteful) disagreements within HealthUnlocked, we face in diagnosing and treating this disease. Examples: not screening and screening fall within the very broad SOC range from barely acceptable to ultimate in care. As do the disparities of use or do not use ultrasensitive PSA testing. As does what PSA value should be relied on for identifying recurrence after RP. As does if/when/what method of imaging should be done. Same for if/when genomic, genetic and blood biopsy testing should be done. Same for if/when debulking is done. Plus, realizing volume and contracting incentives and volume vs. value base care incentives impact medical recommendations, all protected by SOC.
no gsun, not at all what I wrote; puzzled you seem to have extracted this. Paraphrasing a great line from Indiana Jones and the Last Crusade, 'wisely choose' which SOC one wishes to follow. For it is a broad spectrum of care, from marginal (or worse) to 'exceptional' - both of which are opinion/practiced based.
Again, take ultrasensitive PSA. Some members argue strongly against it as do some centers and doctors. I rely on ultrasensitive testing, as do the doctors I choose to consult with. Thing is, SOC includes the use and non-use of ultrasensitive PSA testing.
Another example, I get blood biopsy testing when members and docs would say No! Again, this disparity in useage is inclusive within SOC.
another no, a doc outside of the broad spectrum could more likely face legal and licensing challenges. For me, the treatments I take on, or take a pass on, are my decision as well.
Now I'm really confused. If you choose treatments outside the broad spectrum, your doc cannot recommend that as he could face discipline. So you are on your own? How does that work? Not trying to be a pain, just trying to understand.
ok, I like discussions, even polite debate; pleased you are not harassing. Examples of how I see this topic:
Nine years ago when I was investigating many treatment options, I traveled and consulted with a doc in England about HIFU. At that time in the US you had to leave the county, maybe with an American doc, to get HIFU ( I know men that traveled with US doc to Mexico for this treatment). I think it is fair to say back then HIFU was outside of the US SOC spectrum - and a US doc offering it in US would have been at legal/licensing risk. Today, HIFU is available within the US SOC. Note, some say it is 'bad treatment' - I am not taking a position on HIFU although I did consider it.
Consider screening. Doctors can recommend screening and not recommend it within US spectrum of SOC. I screened in my 40's with a US doc - he and I screwed up and missed the very thing we were screening for - prostate cancer. Other men were not screening because their docs said not needed. Yet we came to have metastatic caner. Well, my doc that missed my cancer, for at least several years, was within US SOC spectrum. Doc's that even today say do not screen are within US SOC spectrum.
To your question are we are on own - IMO we face many disparities within US SOC broad spectrum for prostate cancer and I choose to be a strong self-advocate. As for treatments well outside the broad spectrum, yes it seems to me we are on our own.
I take phytochemical supplements to theoretically fight remaining cancer stems cells (yes might be wasting my monies). Although this is not regulated, nor 'approved', and in fact supplement packing have disclaimers, I think this 'treatment' might be considered within scope of US SOC, because I can buy the supplements here in US, and I have doctors overseeing my self-directed efforts, while not endorsing my taking of these.
In my experiences many docs are 'stuck' in their particular box. Seems to me I have to decide on the 'box of investigative methods' and 'box of treatments' I want, then finding doc's that practice within these boxes. For example, I choose to rely on ultrasensitive PSA, so I do have to find docs that agree with ultrasensitive testing.
Two books by Dr. Marty Makary are very much worth a read. unAccountable and The Price We Pay. Marty points out how there is no accountability in healthcare and the exorbitant prices charged are what has broken the healthcare system. Marty doesn't justify or endorsed med-mal lawsuits at all but he does point out the recklessness of many doctors and various healthcare systems.
People who have never been harmed in a way that alters their life forever most likely will not be a fan of lawsuits and med-mal.
In California they have med-mal limits of $250K (set in 1976) and it just changed to $350k and will peak at $500K in the near future. While no amount of money will ever make a person whole again, it brings notice to the lazy or dangerous actions of doctors and some hospital systems.
With 2022 healthcare spending of $4,500,000,000,000 ($4.5T) med-mal of $55B is a drop in the bucket.
The medical liability system costs the nation more than $55 billion annually. This is less than some imaginative estimates put forward in the health reform debate, and it represents a small fraction of total health care spending.
The disparity of care of men here on HU screams for the need of some standards.
I had one doc that was OK waiting until my psa hit a higher number to treat. My 2nd opinion doc was absolutely against waiting longer and gave the very basic explanation, "You have cancer that was not contained and you have a BCR within 8 months of RP. Your level is high enough to justify further treatment. It's in the NCCN guidelines."
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
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