title: An alternative method of determining standard of care in alleged cases of malpractice.
abstract: BACKGROUND
  Physician experts hired and prepared by litigants provide most information on standard of care for medical malpractice cases. Because this information may not be objective or accurate, we examined the feasibility and potential value of surveying peer physicians to assess standard of care.
  
  
  METHODS
  The survey method was evaluated for a medical malpractice case involving a patient hospitalized with abdominal pain. An abstract of the medical record was created that included the patient characteristics and physician decisions most likely to influence patient outcome. The abstract and questionnaire were sent to 16 academic family physicians and to 20 randomly chosen primary care physicians in Iowa who practiced in communities of similar size to the defendant's community.
  
  
  RESULTS
  All 16 academic and 18 (90%) community physicians completed the survey. All respondents judged the patient as presenting with an acute abdomen, and 89% of the community physicians and 100% of the academic physicians judged the care as below standard. More than half the physicians surveyed listed the autopsy diagnosis (perforated ulcer) in their differential.
  
  
  CONCLUSIONS
  Surveys of randomly selected physicians are feasible to perform for medical malpractice cases. A pro-physician bias has little if any influence on the results.
authors.affiliation: Department of Family Medicine, University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Graber
authors.forename: Arthur
authors.initials: A
authors.lastname: Hartz
authors.forename: Paul
authors.initials: P
authors.lastname: James
authors.forename: Andrew
authors.initials: A
authors.lastname: Nugent
authors.forename: Michael D
authors.initials: MD
authors.lastname: Green
mesh_terms: D000328:Adult; D003625:Data Collection; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007484:Iowa; D008318:Malpractice / Q000331:legislation & jurisprudence*; D010818:Practice Patterns, Physicians' / Q000592:standards*