What are the determinants of a competent neurosurgeon?
Bosk, C.
Clinical Neurosurgery 35: 474-486
1989
ISSN/ISBN: 0069-4827 PMID: 2912652 Document Number: 4880
In making determinations of competence there are some serious questions that we, as a society, have not yet faced. For example, there are no estimates of which I know of how "perfect" we can expect health care to be. Certainly there is no estimate of how much medical error is inevitable, given the complexity of the work. Determinations of incompetence are hard to make without this kind of baseline data. That much said, it is clear that supervision and hierarchy exercise a potent constraining influence on individuals and that errors are fewer when they are present. Hence such arrangements enhance competence. Unfortunately, at present physicians define such forms of practice as residency or punishment or both. However, as old forms of practice give way to more centrally administered organizational arrangements, this attitude will change. The key problem will then be maintaining in definitions of competence a professional ethic of service despite the bureaucratic hostility to it. For without an ethic of service, competence loses much of its meaning and much of its value.
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