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🛑 He Woke Up Missing 16 Teeth... And Never Said Yes.

In 1931, Clarence Hughes went to a dentist for simple mouth pain. The dentist put him under crude anaesthesia without a word about the plan.

When Clarence woke up? 16 teeth were gone. His tonsils were removed.

He died a week later. His widow sued—not for the death, but because he never consented to the procedure.

⚖️ The Shocking Verdict: She LOST the case.
In the 1930s, the medical ethos was "The Doctor Knows Best." As author Jay Katz wrote, the patient's role was simple: "Sit down, shut up, and be a patient."

⚠️ The Hard Truth for Anesthesiologists Today
That "Silent World" is dead. Today, silence is malpractice. We often treat the Consent Form as "just paperwork," but it is your single most important document.

Why? Because of two brutal realities:
1️⃣ Consent is Mandatory: Always take specific informed consent before anaesthesia. No exceptions.
2️⃣ The "Surprise" Factor: Relatives might accept a complication, but they will never accept an 'On-Table Death' if they were never told it was a possibility.

If you haven't explained the risk of death—however rare—the family will view a tragedy as negligence, not a known complication.

The Bottom Line:
Confidence is good. Informed Consent is better.
Don't just get a signature. Get an understanding.

👇 Discussion:
Be honest—do you explicitly mention "death" as a risk in your routine consent for high-risk cases? Or do you skip it to avoid scaring the patient?

#AnesthesiaSafety #MedicoLegal #PatientSafety #InformedConsent

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Confidence Rises Faster Than Ability: A Critical Perspective for Anesthesiologists

In anesthesia, “confidence rises faster than ability” is not just a clever line—it is a real patient-safety hazard. Overconfidence in airway management, regional blocks, crisis handling, or central line insertion can turn a routine case into a catastrophe, especially when help is not called early or cognitive aids are ignored. The gap between perceived skill and actual competence is often widest in the first few years of practice—when things have “gone well so far,” but rare complications have not yet been personally experienced.

## The Dunning Kruger Effect in Medical Practice

The Dunning-Kruger effect shows that the least experienced often overestimate their competence, because they don’t yet know what they don’t know. In medicine, this appears as juniors who feel “ready to fly solo” after a few successful intubations, blocks, or cardiac cases, underestimating complexity and overestimating their safety margin. The danger is not confidence itself, but uncalibrated confidence—technical skills that are still developing, wrapped in a belief of “I can handle this,” without backup, checklists, or senior input.

## Short Examples from Anesthesia

- A junior anesthesiologist persists with repeated laryngoscopy attempts in a difficult airway instead of calling for help or moving early to a surgical/alternative airway strategy.
- A newcomer to ultrasound-guided regional anesthesia attempts deep or high-risk blocks after a short learning curve, misjudging anatomy and complications such as LAST, pneumothorax, or phrenic nerve palsy.
- During intraoperative hemodynamic collapse (e.g., protamine reaction, severe RV failure), a relatively inexperienced provider delays escalating to a senior colleague, believing they can “stabilize first,” losing critical time.
- An anesthesiologist comfortable with landmark central venous cannulation skips ultrasound, leading to carotid puncture or pneumothorax that likely could have been avoided.

Each of these reflects the same pattern: the practitioner’s confidence curve is ahead of their true experience curve—and the patient pays the price.

## The Learning Curve: When Confidence Exceeds Competence

Research in skill acquisition demonstrates several phases:

1. Unconscious Incompetence: The learner doesn't know what they don't know
2. Conscious Incompetence: Awareness of limitations develops during initial training
3. Conscious Competence: Skills improve but require deliberate effort—DANGER ZONE where confidence often exceeds ability
4. Unconscious Competence: True expertise with automatic pattern recognition

The "Conscious Competence" phase (stage 3) represents the highest risk period. Practitioners have achieved basic technical proficiency and experienced some success, leading to inflated confidence. However, they lack the extensive experience necessary for pattern recognition, crisis anticipation, and management of rare complications.

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