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Disputes and Conflict

The relationship between the house staff and the members of the medical staff who are not part of the teaching faculty can be very tense. Staff physicians often resent the house staff 's interference in the care their patients receive. It is essential that the hospital provide a mechanism for members of the medical staff to limit the authority of the house staff to write orders on nonteaching service patients. The simplest way to accomplish this is to allow the staff member to require that all orders on that member's patients be countersigned or verified by telephone. This does not prevent a member of the house staff from questioning an order that the house staff member is asked to carry out. A house officer may refuse to execute an order that seems incorrect, just as a nurse can. But this does not allow a nurse or house officer to change an order.

This limitation upon house staff practice is necessary because the relationship between the patient and the patient's chosen attending physician must have a higher priority than the relationship between the patient and the house staff. The patient may choose to reject the attending physician; but, until this occurs, the orders of the attending physician must have priority. If the patient is injured by a negligent order of the attending physician, the attending physician alone will be liable for the injury (assuming that the hospital has not neglected its monitoring duties). If the injury is due to a house staff member overriding the orders of the attending physician, the house staff member and the training program will be liable for any injuries that the patient suffers. The hospital will also be liable if the nursing staff carried out the order against the instructions of the attending physician.

There is always a potential for conflict between the attending physicians and the house staff. The house and medical education program should develop a mechanism for resolving these conflicts before they lead to staff dissatisfaction or injury to a patient.


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