Competence and scope of practice

Practising within one’s competence sounds straightforward and is breached constantly, usually with good intentions: a patient presents with something outside your training, no alternative is available, and you do your best. That is sometimes the right decision. It is a decision that has to be made deliberately, documented, and supported.

Competence has several components

• Knowledge of the condition and of the evidence
• Trained skill in the specific method
• Supervised experience with this population
• Cultural competence and orientation for this person
• Current fitness to practise — your own health, capacity and circumstances

When there is no alternative

1. 1Assess honestly what you can and cannot do.
2. 2Tell the patient plainly what your limits are.
3. 3Obtain supervision or consultation specific to this case.
4. 4Read; take the relevant training.
5. 5Document the reasoning, including why referral was not possible.
6. 6Review, and refer if the situation changes.