I was flummoxed that the man designated as my trained surgical assistant needed me to ‘talk him through’ the procedure. I wonder if he would be willing to be ‘talked through’ flying an airplane or defusing a bomb for the first time. I’m sure that the patient’s family seated nervously in the waiting room would be reassured by his brash confidence to proceed on their elderly relative.
Was I nervous? Not at all because I knew that this man wasn’t going to touch my patient. I relieved him on the spot and arranged for the procedure to be performed by an individual trained to do so.
What if I had decided to ‘talk him through’ the procedure? What if he didn’t disclose that he was inexperienced? How much do patients really know about the competence of their physicians and those who assist them?
Studies have shown that most patients believe that their personal physicians are highly qualified, but how do they really know this? The scary truth is that they don’t and they can’t. Even experts in quality assessment can’t agree on how to measure medical competence, so I doubt that ordinary patients have cracked the code of this enigma.
Next posting I’ll offer some the ways that experts measure medical quality and why they don’t quite measure up.