• Anaesthesia
• general

From a governance perspective, the professional processes that govern the safe performance of clinical procedures are covered under the umbrellas of medical registration, credentialing, audits, performance appraisal and supervised training with logbooks; however, if we analyse them carefully, it is soon clear that these structures leave a gap, as they do not adequately recognise the rare procedures that some clinicians will have to do only once in a blue moon or a career, whichever is longer.

What defines a routine clinical procedure, an occasional one and a rare one? What do these questions mean for major and minor procedures, for the practice of emergency medicine, for training programmes and for senior doctors learning a new skill?

The reason for asking these questions is because from time to time this journal is sent a case report that describes an author's need to perform a major but rare life/organ saving procedure. Authors will have several reasons for wanting to publish a report eg, for peer education, to solicit other people's experience of the problem (thus getting feedback in a rudimentary audit process) and perhaps, most importantly, as a catharsis and debrief for what may have been an extremely stressful experience, especially if there was a poor …