In Clinical Standards in Medicine medical expert witness Barry E. Gustin, MD, MPH, FAAEM, writes:
Forces both inside and outside of medicine are responsible for the trend towards the development of clinical standards. Physicians have been motivated by their desire to establish acceptable levels of care within the various specialties. This ultimately homogenizes and standardizes the basic approach to patient’s problems, is patient-centered, allows for the development of quality assurance and improvement programs, and demonstrates to the public that physicians as a group are concerned about the quality of care they provide to their patients.
Forces outside of medicine, however, are probably more potent than these internal forces at bringing increasing pressure to the issue of standards development. Malpractice carriers see the creation of widely-accepted clinical standards as one route towards reduced malpractice losses. Ditto for several states, including Maine and New Jersey, which have mandated the development of clinical standards because of their involvement in underwriting malpractice insurance plans.
The high cost of medical care has been a major motivating factor for third-party payors to support the development of clinical standards. Likewise, the federal government is taking an increasingly active role in the genesis of clinical guidelines. Several agencies, including the Department of Health and Human Services, are being charged with the task of establishing many of these standards of care for specific medical problems, including, for example, back pain and depression.