John Livingston News

Standard of Care / Standard of Practice

As a young child growing up in Philadelphia, I early on became interested in the lives of our Founding Fathers. My curiosity continued and when I was a young surgical resident I was given as a gift a book entitled PHILIDELPHIA MEDICA. In Colonial times, Philadelphia was our country’s largest city, the center of commerce and finance, and the home of the Continental Congress and The Constitutional Convention. It was also home to our countries 1st medical school, 1st free hospital. The 1st department of public health, and the 1st mental health institution.

There were four physicians who were signers of The Declaration of Independence but only one had actually gone to medical school—Benjamin Rush of Pennsylvania. In Philadelphia, there were other patriot physicians who likewise put their own lives and fortunes on the line during our Revolutionary War. Dr’s William Shippen, John Morgan, and John Royal Moore all supported General Washington’s Army. They also attended courageously to citizens during smallpox and yellow fever epidemics that would take the lives of 30% of the population from 1776 till 1786—500,000 people in a country of 2.5 million. The death rate during that period was 3.0 compared with the mortality rate from Covid-19 of 0.003—1000 times less!

George Washington and Benjamin Rush were some of the 1st people to utilize a process called “vacuolation”—an early form of vaccination, to protect citizens and soldiers against smallpox (variola major and minor) that prior to its use had death rates in the population of 30%. This was 20 years before Edward Jenner developed a standard vaccination for smallpox. By going out on a limb Benjamin Rush was not practicing to a standard of care or to a standard of Medical Practice. He was severely criticized and ostracized from the medical community for several years. And he saved thousands of lives.

It was almost at precisely that moment in time that the art of Medicine became “Empiricised”, and the scientific application of physiologic and anatomic principles became part of clinical medical practice. The scientific application of public health principles also became the “standard of practice”. Benjamin Rush and his Philadelphia group of physicians were all instrumental in many of the advances that took place in our country that allowed us to move from medieval dogma to science based medicine and like their predecessors in the field of “philosophy and science” Copernicus, Bernoulli, and Galileo they did so at great personal and political risk

Today it is oftentimes said that a political narrative drives the science. It is easy to say that the media and the progressive movement use the word science only when it fits their purposes, but very few have an appreciation for the Scientific method or its limitations. You would never hear a scientist say “this is settled science” That sounds more like something Pope Urban VIII would say to Galileo. I think there is something deeper than political narrative being played out today. St. Thomas talked of “1st instances” or underlying principles which were the bases for all of an individual’s actions. The founder of the idea of THE NATURAL LAW that is defined by others as “an order known in the hearts of all men through the faculties of reason and revelation”, identified a method to approach all questions in the physical and social and political worlds. A culture devoid of principles is what is defining the debate about Covid-19, Global Warming and Climate Change, and many other issues. How do you argue with someone who has no predicate on which to base their position?

I believe that the courageous clinicians in our hospital wards and ICUs have taken up the fight against the dreaded Corona Virus and they are following in the traditions of the great doctors and nurses who have proceeded them. New and innovative ideas are being used all over the country. Standard rules for the dissemination of clinical information “Peer Review”, double-blind, prospective, Certified by the FDA” are being circumvented and new strategies for fighting the virus are being deployed and the same “old guard establishment” is standing back and criticizing the innovators who like Benjamin Rush are saving lives with their new ideas and approaches. It takes courage to practice outside the lines of “standard of practice and standard of medical care”. But what we are seeing is what lawyers have known for a long time—there is a difference between the standard of practice and the standard of medical care. The standard of care is what is written down in a book or a set of bullet points under the heading of “best practices”. The standard of medical practice is what doctors and nurses actually do. When Governor Cuomo of New York and the NY state legislature passed laws indemnifying their gross mal-practice when they purposefully sent COVID-19 patients back to nursing homes who then infected the most vulnerable patients in our society, they tried to make a standard of practice a standard of care after the fact. Doctors are sued every day for negligence and this was surely an act of negligence En Masse.

And the information given to our Governor and those on the task force needs to be looked at. Tonight in our 2 ICUs in Boise, Covid-19 patients make up 25% of the total number of ICU beds and 50% of the total patients using the ICU. In one ICU there are more trauma patients than there are Covid-19 patients. Having an ICU RN on the task force would be helpful in giving our Governor a perspective, but what he should really do is show up tomorrow in the ICU of each hospital in a hazmat suit and assess the situation for himself.

On the other hand, most in the public health community are following a “standard of care” that sets a limit on how they can impact the virus and the way it interacts in the community. This puts a “cap” on innovation. It would be like Benjamin Rush using bleeding and leaches to treat smallpox—which was the standard of care, and not looking for other solutions. It was always stated that the reason for type 1—lockdown mitigation strategies, was to flatten the curve not cure the disease. It was always known that in those areas where the disease was less active in the 1st wave, was where the disease would be most active in the 2nd and 3rd waves. We should have had a strict type 3 mitigation strategy in place late last summer. When we either have “herd immunity” via vaccination or the natural spread of the disease, the disease will have run its course.

So people of courage like Benjamin Rush had to have the courage of their convictions. Many were literally laughed out of town. They had to ask of themselves this question: “Is political ideation or a political narrative more important than one’s truly held convictions?” And in the end, is being true to your convictions if based on sound reasoning more important to one’s reputation than following the crowd with a political narrative?

It is just like Aquinas believed. Applying 1st principles to every aspect of one’s life makes it easy to not have to follow the crowd or see where the political winds are blowing. Is it any wonder that the same group of brave physicians who were willing to put their own reputations on the line to save the lives of their patients during a great smallpox epidemic, were also willing to “place their lives and property, and sacred fortunes” on the line in order to stand up for liberty?

It is time for the political pandemic to be attacked on the public health front using the same innovative thinking that is being used to treat patients by clinicians.

Are our children being taught about “1st Principles” and simple values and virtues today in our homes and schools? Or is blind unquestioning obedience the order of the day? This evening I saw a guy and a gal riding double on a motorcycle down a snowy mountain road and both were wearing masks and neither was wearing a helmet. Their choice for sure, but I couldn’t help but think they were both Democrats. Has common sense died and been replaced with “political correctness”? Watch out for the dreaded CORONA—or the bogyman.

2 replies on “Standard of Care / Standard of Practice”

Proper nutrition and getting rid of bed bugs is all that was needed to stop the “small pox epidemics”. Not a “vaccine” that was more deadly than the dis-ease.

Interesting comments about BED BUGS Many felt the same in Colonial times and prior to the battle of Trenton bedding and laundry were placed in contact with British soldiers in Trenton, Princeton, and Pennington. 15 years later Edward Jenner disproved this idea during his quest for a true vaccine for small pox—as opposed to the vaculation process used by Washington and the Colonials. Thanks for your commnents.—-jml

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