How many of these have you done?

A recent opinion piece in the Journal of the American Medical Association drew attention to the issue of procedural experience in healthcare.

Titled “How many have you done?”, the piece described the experience of a doctor who required a procedure herself, in this case, an amniocentesis.  In the piece, she questioned her doctor on the number of times he'd performed the procedure.

Of course, what she was really asking is, “How can I be reassured you know what you are doing?”

The thrust of the piece was that the training doctor had felt compelled to misrepresent their experience with the technique, deftly deflecting questions by the patient and her partner that explored his competence.  The author calls for a more honest response to these types of questions, while acknowledging that this is often difficult to do.

But is it any wonder a young doctor has trouble answering this question?

Healthcare continues to battle with the issue of competency.  It is still rare for doctors to be formally certified to perform specific procedures.  In fact, the industry still does not have a shared understanding of what competency actually is!

Furthermore, because it is uncommon for doctors to assiduously record their activity and outcome data, and even more rare for them to benchmark against their peers, most clinicians are simply oblivious to their level of performance.

So when patients are searching for reassurance that they will be cared for as best they can be, most of us struggle to be clear and meaningful in our response.  Because most of the time, we just don’t know.

Wouldn’t it be much better for the junior doctor to answer with authority?

“Well, I’ve completed a recognised pathway and been certified to practice after a period of supervision by experts.  Furthermore, I continuously review my performance results and feel comfortable that I’m doing well.”

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