The Community Standard
The community standard is the older standard and reflects the traditional deference of the law toward physicians. It is based on what physicians as a group do in a given circumstance. The community standard requires that the patient be told what other physicians in the same community would tell a patient in the same or similar circumstances. “Community” refers both to the geographic community and to the specialty (intellectual community) of the physician.
The community standard usually requires that the patient be told little about the risks of the treatment or possible alternatives. In the extreme case, the community standard can shelter, telling the patient nothing other than the name of the proposed treatment and a brief description of it. In this extreme situation, physicians choose not to inform patients about the risks of the treatment.
The community standard has the most extreme results in very limited subspecialty areas of practice. In these areas, the number of practitioners is small, and there are only a few training centers. This results in an intellectually homogeneous group of physicians who tend to approach patient care in a similar manner. It is common for subspecialty practitioners to become true believers in the efficacy of a given treatment and to promote that treatment to patients. In this situation, the community standard will be to offer the patient only enough information to convince him or her to have the treatment. Risks will be ignored because the physicians have convinced themselves that it would be unreasonable to refuse the treatment.
Another area in which the community standard becomes a problem occurs when a small group of a larger specialty adopts a therapy that is rejected by the majority of the specialty. Since informing their patients of the majority view would make it impossible to perform the procedure, the minority-view physicians must ignore the controversy. For example, there has been a great controversy in ophthalmology over performing radial keratotomies. A small group of ophthalmologists began performing this procedure on large numbers of patients without traditional controlled studies on the benefits and long-term risks of the procedure. [Freifeld K. Myopic haste? (100,000 plus have had new eye surgery). Forbes. May 6, 1985;95:135.] A disclosure based on the views of the majority of the profession would have required that the patient be told that this was an unproved, experimental treatment that carried potentially severe long- term risks. Fewer patients would consent to an essentially cosmetic procedure if given this information. As a result, the majority view was discounted, and patients were told little about the uncertainty concerning the existing and future risks of the treatment. When a national study panel disputed this practice and called for proper studies of the procedure, the advocates of radial keratotomies sued the members of the study panel for antitrust violations. [Norman C. Clinical trial stirs legal battles: legal disputes in Atlanta and Chicago over surgery for myopia raise issue of how controversial surgical techniques should be assessed. Science. 1985;1316:227.] The court found these allegations groundless and ruled for the study panel members. [Schachar v. American Academy of Ophthalmology, Inc., 870 F.2d 397 (7th Cir. 1989).]