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August 14, 1996

Another Standard of Care—The Patient-Reply

Author Affiliations

South Dartmouth, Mass

JAMA. 1996;276(6):450. doi:10.1001/jama.1996.03540060026022

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In Reply.  —I appreciate Dr Kellerman's thoughtful commentary regarding the addition of another standard of care to the list described in my article.I had, in fact, considered including the patient's standard of care as a separate entity from the others. Rather than portray it as another standard, however, I preferred to incorporate it into the physician-patient relationship in the personal standard of care. As I noted in the original piece, by applying that personal standard of care, "The physician is thus better able to educate the patient about medical issues, thoughtfully listen to and address the patient's needs and desires, and incorporate the patient as an active participant in an individualized care plan."The patient's needs, desires, fears, and previous direct or indirect medical experiences all contribute to an expectation—a "patient standard of care" if you will—that needs to be recognized and addressed by the physician.By listening to the patient,