Arthur L. Caplan, PhD
Hi. I’m Art Caplan from the Division of Medical Ethics and the New York University (NYU) Langone Medical Center.
A former student of mine, who is now in medical school, asked me a question that comes up again and again. I have not talked about it here, but I think it does merit some discussion. The question is: What do you say to a patient when you have not done a procedure frequently or recently? How much do you share with them about your level of experience? The student who asked me was not lacking in confidence that they could do it but felt, nonetheless, that if they said, “This is the first time I am doing X,” then the patient would get nervous and potentially ask for somebody else.
There are a couple of instances in which it is morally justified to, at some point, try a procedure on a patient in which a doctor has no experience for the first time. For many situations, the students—younger people who are doing this—are in training. They are in academic teaching hospitals. Unless people are brought into the emergency room, they know that they are in teaching hospitals and can make a choice as to whether or not they want to go to that kind of a setting.
Also, doing procedures for the first time or trying to learn them better, you are often getting expert supervision. All kinds of people who are on the surgical team know very well what is going on. You may even get the latest and the best version of that procedure. There is the advantage that, even if you may not be as agile or as dexterous as an experienced doctor, a lot of people are watching over you, so you provide a higher quality of care because of the nature of the teaching environment.
There are situations, though, where it might be important to stand down if a patient asks for something that you are not ready to do. I have seen a situation where a celebrity patient or a very rich patient came and said, “I want the chairman to do this procedure on me.” In one case, the chairman really had not been doing procedures. He had been doing a lot more administration and a lot less clinical care. It may make sense in that kind of a situation to say, “I am not the best person to do this. I am not going to be able to do it as well as some others who are doing it every day on the front lines. I will be there. I will sit in, but you do not really want me.”
I can imagine situations where getting rusty might be a reason not to offer a particular intervention to a patient until your skill level returns by sitting in and watching an expert perform the procedure and slowly learning again, as people do when they are first starting out. In general, it is morally defensible to be performing a procedure for the first time when you are learning, because you have the supervision. However, it may be important not to jump in if you have not done something for a while. You may need retraining in order to make sure that you are giving the best possible care.
I am Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center.
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