By BARRON H. LERNER, M.D.
Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Yet even though such acts can jeopardize patients, the inclination and ability of young doctors to speak up is hampered by the hierarchies in teaching hospitals....
This new division of labor established hierarchies. On the top were the senior physicians who made rounds on the wards once or twice daily. Next were the overworked residents, who essentially lived in the hospital while training. Last were the medical students, who spent the most time with patients but were most assuredly at the bottom of the heap.
Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And students were all too easily intimidated. In a 1993 article in The New England Journal of Medicine, a Harvard medical student reported that although her resident routinely made derisive remarks about her patients on rounds, the rest of the team laughed nervously rather than confront her....
The student whose resident seemingly lied to the attending physician about the blood test did not speak up either. The resident was a good doctor, she said, and so she had given him the benefit of the doubt. And, she added sheepishly, both the resident and the attending physician would be grading her.
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