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June 20, 2007

The Locality Rule and the Physician's Dilemma: Local Medical Practices vs the National Standard of Care

Author Affiliations

Author Affiliations: Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, Md (Dr Lewis); Greenwall Fellowship Program in Bioethics and Health Policy, Johns Hopkins Berman Institute of Bioethics, Baltimore, Md, and Georgetown University, Washington, DC (Dr Lewis); Division of Cancer Prevention, National Cancer Institute, US National Institutes of Health, Bethesda, Md (Dr Gohagan); and Department of Family Medicine, Georgetown University, Washington, DC (Dr Merenstein).

JAMA. 2007;297(23):2633-2637. doi:10.1001/jama.297.23.2633

The purpose of medical malpractice law is to protect patients from substandard medical care and to compensate them for injuries sustained as a result of substandard care. Each medical malpractice case serves an additional function by further delineating the medical care that is legally acceptable in a particular field.

Although medical school training, medical licensing requirements, and board certification requirements are based on national standards, many states rely on local practice standards to determine the applicable standard of care in medical malpractice lawsuits. Jurisdictions that maintain local practice standards may inhibit the incorporation of scientific progress into practice standards. In addition, adherence to the locality rule can create uncertainty for physicians when they must choose between following local practice standards and national, evidence-based standards for care.

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