Saturday, May 03, 2008

Bring on the trainees...

In the barber shop that I go to, there is a certain protocol for training new hands. The first few weeks, the new recruit does some basic and miscellaneous work, like putting on the towel, spraying some water, handing over scissors or knife to the master, dusting the hair off the face – in short, activities with no scope for inflicting any harm on the customer. After some time, he moves up the ladder and tackles responsibilities such as shampooing, drying, an odd shave or two, head and neck massage and such stuff. Then he is gradually entrusted with the responsibility of hair-cut, through a surreptitious process. He will be inflicted on unwary customers or small boys who can’t complain or won’t spot the difference. If a trainee barber were to be assigned to a seasoned campaigner like me, the pretender will be pushed aside summarily and a demand raised for the real one.

So, how does the trainee get trained? If never allowed to get hands-on, he is never going to get the confidence and the master will never get to have subordinates he could delegate the work to.

If the training process for hair-cuts has to overcome so many obstacles, imagine the plight of the trainee surgeons in the medical profession. In his book, “Complications: Notes from the life of a young surgeon” written when he was a Resident, Dr.Atul Gawande observes :

In surgery, as in anything else, skill and confidence are learned through experience- haltingly and humiliatingly. Like the tennis player and the oboist, we need practice to get good at what we do. There is one difference though in medicine: it is people we practice on.

.. We find it hard in medicine to talk about this with patients. The moral burden of practicing on people is always with us, but for the most part unspoken. ..There is always that conflict between the imperative to give patients the best possible care and the need to provide novices with experience.

..By traditional ethics and public insistence, a patient’s right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden behind drapes and the anesthesia and the elisions of language.

..Do we ever tell patients that because we are still new at something, their risks will be inevitably higher, and that they’d likely do better with others who are more experienced?.. I’ve never seen it. Given the stakes, who in the right mind would agree to be practiced upon?

Can people be persuaded to take on chances for societal benefit? We’d ask patients- honestly, openly- and then they say yes? Hard to imagine.

In fact, Dr Gawande answers that last question, by admitting that when he was confronted with a medical emergency involving his son, he decided to go to the cardiologist-in-chief, rather than a junior surgeon, as he wanted the best medical care for him. So, he concedes that, if at all the choice is offered, it is not done equally. The rich and the knowledgeable have and exercise that choice. The doctor’s child has that choice, but not the truck driver’s.

So, the next time you are at that humble barber’s shop, the swanky beauty parlour. in a plane or, unfortunately at the surgeon’s table, spare a thought for that trainee. Because, even if you don't spare that thought, the work is probably getting done by the trainee anyway. Who knows who is operating on you, under cover of anesthesia, or who is flying that plane inside that locked cockpit?

2 comments:

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