Any doctor who specialises in a particular field would be expected to keep up-todate in that area. This would apply to all fields of medicine. Surgeons with a special interest would be expected to keep up-to-date with developments both in the field of general surgery and their area of special interest.
A patient and indeed a court of law would expect the practitioner to have a reasonable grasp of current concepts and ideas, as well as any controversies within their specialist subject. This means reading the latest peer-reviewed journals from across the world, and attending postgraduate meetings and conferences organised by specialist societies.29
Obstinately persisting in using outdated techniques contrary to recognised opinions and evidence is both unprofessional and unethical, especially when those techniques have been shown to cause demonstrable harm in the past.
A clinician may be perfectly competent and capable at one moment in their career, only to find their competence being challenged at some subsequent time. This may be due to illness or deterioration in physical health. It might follow a temporary (or extended) absence from clinical practice, or reflect psychological or emotional problems.
"The culture of the future must be a culture of safety and of quality; a culture of openness and accountability; a culture of public service; a culture in which collaborative teamwork is prized; and a culture of flexibility in which innovation can flourish in response to patients." Sir Ian Kennedy, Bristol Inquiry.30
In all these cases, it is a clinician’s responsibility to ensure that at all times they are able to carry out medicine safely, and to an acceptable standard. Where there is any doubt that this is the case, the clinician has an ethical duty to seek appropriate (eg, medical) advice, and to act upon it.
It can be difficult to maintain an objective evaluation of your specialist competence and ensure you keep up-to-date, while also focusing on patient care in an intensive working environment. Appraisals and revalidation have an important role for every clinician, and you can also help colleagues by the feedback you give and how you yourself receive feedback
Learning from colleagues
To learn only from one’s own mistakes would be a slow and painful process and unnecessarily costly to one’s patients. Experiences need to be pooled so that doctors may also learn from the errors of others. This requires a willingness to admit one has erred and to discuss the factors that may have been responsible. It calls for a critical attitude to one’s own work and that of others.
No species of fallibility is more important or less understood than fallibility in medical practice. The physician’s propensity for damaging error is widely denied, perhaps because it is intensely feared… Physicians and surgeons often flinch from even identifying error in clinical practice, let alone recording it, presumably because they themselves hold… that error arises either from their or their colleagues’ ignorance or ineptitude. But errors need to be recorded and analysed if we are to discover why they occurred and how they could have been prevented.
The Critical Attitude in Medicine: The Need for New Ethics, by Professor Neil McIntyre and Sir Karl Popper (1983).
Summary
The unsettling fact that healthcare can harm as well as heal us is why it is at the heart of healthcare quality. The wider public wants a health service in which they can take the optimum performance of their doctors for granted. The biggest challenge for doctors in the future is whether they are able to meet these expectations.
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