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Supervision of doctors in training may require guidelines

As some Oregon patients know, patient care in teaching hospitals is often handled in part by physicians in training. These resident doctors have backup and may call supervising physicians. A recent study looked at when the call for advice should be made in a pediatric setting and whether guidelines might be needed to address this issue.

The study surveyed 50 attending physicians and 62 residents in a Massachusetts children's hospital. It presented both groups with 34 situations and asked if an immediate call for consultation was necessary. The scenarios included situations where a patient requested a transfer to a different hospital, issues with medication and clinical questions.

The results differed between the two groups. In 18 scenarios, many residents said calling a supervisor immediately would be best. Supervisors opted for an immediate call from a resident in 26 situations. In some cases, where a patient's condition was deteriorating quickly or if a medical mistake was discovered, both groups agreed that an immediate call would be appropriate. In others, agreement that the call might be delayed was shown.

The biggest discrepancy was when a patient or family members were angry. Other situations included patient restraint or when an procedure could not be performed. In these situations, more residents wanted to wait while more supervisors said they wanted an immediate call. Of all residents, about six out of 10 were unaware of the availability of guidelines. In some situations, there were statistical differences between senior and junior supervisors.

If patient care is affected by a lack of hospital guidelines, a patient's life may be put in danger in some circumstances. The patient may benefit from consulting an attorney who may examine the case and determine if hospital negligence occurred. In situations where this can be demonstrated, the attorney may recommend the filing of a medical malpractice lawsuit seeking appropriate damages.

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