Following the American Psychological Association’s Guidelines
- There are several issues with the credentials in this case study. Laparoscopic laser cholecystectomy procedure has been refined since its initial conception, and is much easier that it was years ago. However, it is still a complicated procedure. The fact that it is now offered on a consistent outpatient basis may be the reason that medical facilities, such as the one mentioned in the case study, consider it worthy only of workshop certification. Another reason may be that it is considered minimally invasive, which is a phrase that, according to “Ensuring Physicians' Competence — Is Maintenance of Certification the Answer?,” can be a misleading phrase .
The procedure itself is very delicate. A laparoscopic laser cholecystectomy refers to what is known as a keyhole surgery, which opts for a small incision in the abdomen, versus large incisions in other areas of the body. This particular surgery, as the case study noted, was dealing with gallstones. Working in such small areas calls for a level of experience and preciseness that a workshop simply could not offer, no matter what the keyhole surgery was attempting to fix.
John K. Iglehart and Robert B. Baron, authors of, “Ensuring Physicians’ Competence” point out workshops can be very beneficial in many areas of medicine. If an educationally accredited doctor needs to learn a new technique or refresh on old techniques, workshops can be very beneficial. This, Iglehart and Baron say, is because the doctor already has experience with the subject at hand, and a solid foundation in medicine already; the workshop is not providing the medical foundation alone .
In the situation with “Candler Vs Persaud,” Dr. Freeman had no prior known experience to keyhole surgeries, nor any prior experience to gallstone removal. His only medical foundation for the procedure, or remedying anything that might go wrong with the procedure was based on what he had learned at a workshop. Iglehart and Baron admit that while workshops are helpful, they do not provide lifesaving information. Workshops are refresher courses or avenues for doctors to learn new techniques that they should continue perfecting. Workshops do not hold all of the benefits of an education and, therefore, hold no basis in the medical field when it comes to a doctor performing a procedure, whether assisted by a professional or not.
With this in mind, the credentialing issue in this case is simple: Freeman did not have the credentials to perform a procedure of this magnitude. While the procedure has been available for decades, is considered an outpatient procedure, and is even referred to as minimally invasive, it is like any other procedure: issues can still arise. In this case, the patient died from internal bleeding. Because Freeman had only attended a workshop which likely only explained was a laparoscopic laser cholecystectomy procedure, rather than allowed participants the opportunity to learn how to perform it, his credentials were less than satisfactory, if existent at all. At the very least, the staff should be found negligent in this case.
- A hospital should take several steps when ensuring physicians are competent when performing procedures that patients may need or request. The first step is to eliminate the idea that workshops can substitute for an education. As stated in “Competency-Based Theory Medical Education: Theory to Practice,” by Jason R. Snell and his associates, even radiation technicians, MRI technicians, and phlebotomists all have to pass rigorous programs in order to gain certification in their respective fields . These certification programs allow individuals to read about their future career and be tests on paper, but it also gives them a chance to be tests in the field. A portion of most certification programs, referred to as “clinicals,” ensure that students get a chance to practice their occupational duties in the workplace, on patients . This ensures that they are competent members of the workforce when they become certified.
The point the article attempts to make is that individuals, sometimes referred to as cogs, in the medical system, who are running machinery, taking blood samples, and performing tests, have to complete certification programs that can take from 3 to 8 months of tests and clinical practice before they are competent members of the field. However, sometimes we expect medical doctors who are performing invasive procedures to attend a workshop over one weekend to come back competent enough to perform the procedure competently. This setup seems flawed and illogical. If certified nursing assistants and emergency medical technicians must complete months of training courses to do jobs that surgeons and ENT doctors may consider mundane, it is only proper that more instruction be put into educating doctors on new, invasive procedures, such as keyhole surgeries concerning an individual’s gallbladder.
This does not mean to say that the education recommended for a certification is enough to prepare a doctor to perform an operation, but it would prepare those more properly to help patients with their needs. It would also allow the physicians to learn lifesaving techniques that otherwise would have saved the patient mentioned in the case study. In Freeman’s workshop, lifesaving techniques may have been mentioned but in such a short period it may have been difficult to absorb anything that would have helped. It would have been equally difficult to allow every doctor in attendance the chance to answer questions under pressure, or practice administering any such techniques. Because Freeman was the administering physician, he was the one responsible for the patient’s life and, therefore, he was the one that should react the quickest if a problem arose. While there was an overseeing doctor that may have known a technique that could have saved the patient’s life, it may have made little difference.
The fact of the matter is workshops are inefficient when it comes to preparing a doctor to perform a procedure. Just as when they were acquiring their medical license, doctors should be fully educated on all new procedures and techniques that become available to the medical community as time goes on. If doctors are not fully versed in the technique, they should not be allowed to perform the procedure, regardless of if another physician is willing to oversee it. Two ignorant doctors in a room just means there will be two doctors there to watch a patient bleed to death. The only efficient way to ensure that doctors are competent at delivering treatment is to educate them fully, and give them the same courtesy we give individuals that we expect to do all of the mundane work around hospitals. We trust more education to the individuals who take out the waste than to those who are operating on the patients, and that is entirely unethical.
Frank, J. R., Snell, L. N., Cate, T., Homboe, E. S., Carraccio, C., Swing, S. R., . . . Cambell, C. (2010). Competency-based medical education: theory to practice. Medical Teacher, 638-645.
Iglehart, J. K., & Baron, R. B. (2012). Ensuring Physicians' Competence — Is Maintenance of Certification the Answer? The New England Journal of Medicine, 367-369.