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The Standard of Care: Customary Care

The single most powerful standard of care measurement today is customary care. “Customary care” is that care which would customarily be given by other physicians under the same or similar circumstances.[1] Customary care standards are meant to be empirical; they come from doctors asking a significant sample of their peers what they would do if they were faced with the same set of circumstances. In the best light, customary care or “eminence-based medicine,” is a collaborative effort to create the care standard through collective evaluation of actual practices.[2]

The concept of customary care as a measurement for quality originated in the past when accepted practices for clinical problems were more straightforward than those that face today’s clinicians.[3] Physicians simply made subjective, intuitive decisions about what worked based on what they observed. Today, with the chaotic array of clinical choices, ambiguities a