Thoughts From Your Colleagues

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Errors of Commission and Omission

I write in response to Dr. Lanciano’s letter to the editor (October). I admire his unrelenting educational effort on the difference between allopathic or osteopathic training and the training of other health care practitioners, such as chiropractors, nurse practitioners, optometrists, and others. The institutions that credential these professionals—whether they are political, financial, or social— are not knowledgeable about intricacy within fields like medicine or mathematics.

Physicians are set apart in that we are trained to care for complex cases when signs, symptoms, and therapy do not coalesce in a cure. Empirically, we learn in residencies, fellowships, and practice that complications can result from appropriate treatments, medicines, and surgeries. Complications teach us to respect a difference between errors of commission and omission—this is judgment. Then, we acquire what makes physicians unique: the skills, knowledge, and responsibility to have a plan and keep trying when things go wrong.

Optometrists, nurse practitioners, and technicians can aim a laser beam, make a cut, or prescribe a medicine. They cannot care for the complications. The logic that they use in supporting their safe execution of some medical practice is based upon how rare complications are. It is not built on their acquired judgment and reaction skills. When “what usually happens” turns into “what might happen,” these practitioners are unprepared. This is a reason doctors are distinct. I do thank you, Dr. Lanciano, for all you do.

Patrick K. Price, MD, FACS 
Blue Springs, Mo.