Standard of Care: Treatment and Surgery
The standard of care owed to patients is the level of skill, expertise, and care possessed and practiced by physicians in the same or similar community, and under similar circumstances. However, the advent of "national board" exams for new doctors and "board certifications" for doctor-specialists has resulted in a more uniform and standard practice of medicine not dependent upon geographic locality.
General vs. Specialized Knowledge
All licensed physicians should possess a basic level of skill and expertise in diagnosing and treating general or recurring types of illnesses and injuries. Thus, a general practitioner who has administered sub-standard cardio-pulmonary resuscitation (CPR) to a heart attack victim (who subsequently dies as a result of the sub-standard care) cannot claim that he or she was not a "cardio-pulmonary specialist" as a defense. A general practitioner from virtually any other area in the country could likely testify as to the level of care and expertise expected under the circumstances.
Conversely, a board-certified cardiopulmonary specialist could not testify that the general practitioner should have done everything that the specialist might have done with his advanced skill and training. Nor, under the locality rule, could an oncology specialist in private practice in Smalltown, U. S. A., be held to the same standard of care as an oncology specialist in a large urban university teaching hospital that has state-of-the-art equipment and facilities.
“The Conspiracy of Silence”
Because doctors are often reluctant to testify against their colleagues (referred to by lawyers as the "conspiracy of silence"), it may be difficult to find an unbiased expert willing to testify against a negligent doctor regarding sub-standard care. This resistance applies even when they practice on opposite sides of the country: they may know one another from the national board certifications or fellowship programs established for specialists. Moreover, truly competent doctors usually communicate with one another for professional "brainstorming" on diagnosing or treating some conditions, or may collaborate in research or academic publications.