Public Health Law Map - Beta 5 - Medical and Public Health Law Site

No matter how many residents, fellows, or medical students are participating in the
care of a patient, it is the staff physician who is responsible. All the rules that apply
to working with a consultant apply to staff physicians. If the patient is not referred
to the teaching service for all care, then the original physician should be careful to
supervise the patient’s care personally.
When private physicians refer patients to a teaching hospital, they should make sure
that the referral is to a fully licensed physician, not to a resident or a medical
student. It may be a student who takes the telephone call, but the referral is to that
student’s supervising physician. If the referring physician is not certain who is
taking the referral, then this should be determined or the patient should be referred
elsewhere. If a physician refers a patient to a student or a resident without proper
authority, and the supervising physician does not accept the patient, the referring
physician has abandoned the patient and is liable for any problems that arise.
If a physician requests a consultation from a teaching service, both the physician
and the patient should know who on the service will be primarily responsible for the
work and who is the supervising staff physician. If problems arise during the
consultation, these should be worked out between the attending physician and the
supervising staff physician.
c) Maintaining Supervision
A staff physician should never turn over care of the patients on the service to an
unsupervised resident. If the staff physician is unavailable to supervise the service,
another equally qualified physician must assume this responsibility. Although
residents and fellows may have independent licenses to practice medicine, they are
viewed as students and therefore not appropriate substitutes for their teachers.
A physician who undertakes the education of students, whether in private practice
or in the school, has a fundamental duty to supervise their activities. The most
important part of this supervision is making sure that the student does not harm the
patients or interfere with the physician–patient relationship. As a recent study
illustrates, this is complicated by the tendency of residents to hide their mistakes
from their attending physicians, as well as their patients. [Wu AW, Folkman S,
McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA.
1991;265:2089–2094.] This deception can have profound risk management
consequences. [Persson A. Letter concerning: do house officers learn from their
mistakes? JAMA. 1991;266:512–513.] The students must understand the
importance of reporting all problems to the attending physician. It must be clear
that it is expected that students make mistakes. [Bosk C. Forgive and Remember:
Managing Medical Failure. Chicago: University of Chicago Press, 1979.] It is
covering up a mistake that is unacceptable. The physician also must ensure that the
student does not violate the law or go beyond the allowable scope of practice.
Preventing harm to the patients requires close supervision of everything the student
does to or for a patient. It is acceptable to have a student write orders if the nursing
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