People sometimes assume that medical malpractice lawsuits arise whenever doctors make mistakes, but this is not the case. Rather, a malpractice claim arises only when a medical provider’s treatment falls below ‘the standard of care.’

The standard of care is typically defined for a jury as the “duty to exercise the degree of skill, care, and learning expected of a reasonably prudent health care provider in the State of Washington acting in the same or similar circumstances at the time of the care or treatment in question.”

There is additional language often included for a jury, which states, “the degree of care actually practiced by members of the medical profession is evidence of what is reasonably prudent.” This is to say that the standard of care is somewhat self-defined by the medical community’s collective behavior.

Which is what makes the conclusions of two recent medical studies on migraines so alarming.

You can read an article about the studies here:

[Many Migraine Sufferers Given Narcotic Painkillers, Barbiturates](http://www.medicinenet.com/script/main/art.asp?articlekey=189032)

Migraines are intense headaches that are characterized by throbbing pain on one side of the head. The pain may be accompanied with sensitivity to light and sound, nausea, and vomiting. An estimated 36 million Americans are afflicted by migraine headaches.

Guidelines from several respected sources say that narcotics and barbiturates should not be “first-line” treatments for migraines. Rather, such powerful medications should be reserved as a last resort if other medications fail. Those suffering migraines should first try general painkillers, or migraine specific medications called triptans. There are also non-drug options for treating migraines, such as avoiding triggering circumstances.

Despite the guidelines, however, one of the studies determined that more than half of adults with migraines had been prescribed a narcotic painkiller, and a similar number had been given a barbiturate. The other study found that of 21,000 children and teens that presented to an ER or doctor’s office for headache, 16 percent were prescribed a narcotic painkiller. It also noted that doctors who are not migraine specialists were responsible for many of the prescriptions. Emergency room doctors, it was determined, were who most often prescribed narcotic painkiller in response to complaints of headache, followed closely by primary care physicians.

The concern is that narcotics and barbiturates are serious drugs. Both are potentially addictive, can cause withdrawal symptoms, and may even make migraines worse in the long run.

Two reasons have been offered for the studies’ conclusions. One, that doctors who do not specialize in headache treatment may be unaware of the guidelines, or may lack experience with triptans. Two, that doctors are taking the easy way out. A researcher behind one of the studies noted that to use a triptan, a migraine must be diagnosed. Emergency room doctors, in particular, may be more comfortable and used to prescribing narcotic pain medications.

Doctors involved with the studies have called the findings “worrisome” and “upsetting.” It could be argued then, that it is a violation of the standard of care to ignore migraine guidelines and prescribe narcotics or barbiturates first, bypassing less risky treatment options.

And here is where the “what is actually practiced” language is so dangerous. The current situation with migraines appears to be that lots of doctors are making mistakes in treatment, but those same doctors can simultaneously defend that mistake because so many of their peers do the same. And thus the ‘reasonably prudent doctor’ is obscured by poor treatment of a larger community.

In addition to the issue highlighted in this post, there are several other factors that may preclude the prescription of narcotic painkillers for migraines from being a viable lawsuit. The two studies, though, are illustrative of the danger in a self-defined standard of care, which can be difficult for a jury to appraise when many health care providers are failing to do the right thing.