Why don’t doctors think should tell us that when they aren’t very good?

not-adeptI subscribe to several medical ethics feeds on twitter. Since doing so, I’ve often been surprised at how easy some of the purportedly “tricky” ethical questions doctors face really are. This medscape article featuring @arthurcaplan is a perfect example.

The question Caplan, an ethics professor, is answering is: “Should you tell a patient you’re not adept at a procedure?”  It’s hard to think of a much easier “ethical” question to answer.  Yes.  Of course.  Always. The patient has a right to know.  The patient might not want to be a guinea pig.  The patient might want to seek out a more qualified doctor.  The doctor’s desire to improve his or her skills does not outweigh the patient’s right to be informed. 

But not only does Caplan treat the question as though it’s difficult, he argues that most of the time doctors don’t need to tell us they’re not “adept.”  He cites the example of a teaching hospital: “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.”  Yikes.

As a lawyer, the idea of taking on something I’m not “adept” at without telling my client is horrifying.  I wouldn’t handle a divorce, an adoption, a will, a criminal case, or anything outside my wheelhouse, without making that extraordinarily clear to the client.  The fact doctors see the parallel issue as a nuanced or complicated one is frankly disturbing.

The solution, as is often the case in these posts: Ask! (1) When was the last time you’ve done this procedure?  (2) How many have you done this year?  (3) What are the potential complications?  (4) What complications have you personally experienced?  (5) If you had to have this procedure done, who would you go to?

Peter Mullenix