P-R-A-C-T-I-C-E…But not on me!

There are times in our lives when, no matter how strong we think we are, we are placed in a vulnerable situation. Such instances may include a simple visit to a doctor's office or more a severe event such as surgery. At these times, we, as patients, are placed in an extremely vulnerable position. We are ill or injured, and we are putting our health in the hands of another.

Well, what happens when you visit a doctor who appears to be "wet behind the ears", or you find out that your surgeon is actually a resident and the attending will not even be in the room? Does this make you feel comfortable in your vulnerable state, or are you wondering if you are actually getting the best care possible?

A recent New York Times article poses this same type of ethical consideration. According to the article, "to become a medical expert it takes practice, practice, practice, and, unfortunately, some error along the way." This conflict is at the heart of medical training; what might be best for making a skilled, independent-thinking doctor may not always be best for the patient.

In the pursuit of patient safety, educators have deliberately prevented residents from acting independently on their own judgment in situations where a patient poses a theoretical risk. The fact is that all physicians in training pose an inherent risk to patients.

Educators should do everything they can to minimize this risk but recognize that it may impair physicians’ self-confidence. However, it is hard to feel confident and independent unless you are given ample opportunity to stand on your own and risk making a mistake.

And how does a physician obtain that confidence? As stated earlier, practice, practice, practice.

This may seem acceptable to the patient during a simple doctor's visit; however, physicians are in a bit of an ethical conundrum in the more serious situations such as surgery. Is the patient really getting the best care possible in this situation?

Atul Gawande, author of Complications: A Surgeon's Notes on an Imperfect Science1, addresses this same conundrum. Gawande introduced surgeons as human with common human traits and faults. He stressed that, as humans, surgeons must practice their skill.
Gawande then went into further detail to discuss the ethics involved with training. As humans, we must follow a code of ethics; and, as humans, surgeons are no exception.

When given the choice, patients would choose an attending physician over a resident. This decision is based on the fact that patients want the best care possible. However, in order to get that care, surgeons must be trained. Therefore, learning is usually "hidden behind drapes".

While Gawande is a surgeon and he understands the importance of this hidden training, he admitted that he has been guilty of acting like a normal human-being. When his daughter was ill, he chose the best care possible instead of the training opportunity for another physician. With this example, he depicted the human side of a surgeon as being a caring father who only wants the best for his daughter. Therefore, with this example, it appears that there is no simple answer to this training issue.

As a patient, I not only perceive physicians to be infallible but I also expect them to be. However, although surgery has become as high-tech as medicine gets, I guess we must retain a recognition for the limitations of both science and human skill….not very easy to do when your life is on the line.

1.) Gawande, A. Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Picador; 2002.

BW706 Blog #9
By: Lisa Menard