I’ve mentioned before that academic medical centers offer some benefit to some patients. That benefit comes at a substantial cost. You should ask your physician who will you see everyday in the hospital and how much responsibility will that person have? There is now evidence that a majority of medical errors occur due to inadequate resident supervision. That same resident who is providing you with “care” may also be fatigued. This likely increases the risk of you becoming a statistic.

I have worked in many hospitals over the last twenty-five years. Hospital policy varies greatly. Some hospitals require the attending surgeon (the one who will send you a bill) to be in the operating room during every case. Other hospitals have a more “relaxed” approach allowing relatively unsupervised residents to operate, well… unsupervised. I personally applaud the hard-nosed approach that these former institutions take. As more hospitals link CEO pay to overall hospital performance and safety I hope more hospitals will put patients first and ignore self-centered physician demands.

Academic physicians claim that their residents “need” to make a few mistakes. In fact Keith B. Armitage, MD, president of the Assn. of Program Directors in Internal Medicine. “You can’t learn without some autonomy.” The data certainly indicates residnts are expressing their autonomy and making mistakes. This is little more than a boondoggle by academic physicians to escape legitimate patient-care responsibilities. It is frankly flawed reasoning used to justify abdication of real patient-care responsibilities. Academic physicians cannot point to a shred of evidence indicating that autonomy improves resident learning. They cannot show a scintilla of data that adequate supervision is in any way detrimental. Occasionally the physician justifies the lack of presence or supervision by saying “I won’t charge for it.” Inadequate, unsupervised care amounts to fraud regardless of the cost.

Hospitals are frequently complicit. The hospitals allow “relaxed” supervision rules for surgery and medical procedures by only requiring that the attending physician be “available.” Somehow this justifies allowing a resident to operate unsupervised without actual privileges. The supervision rules are clearly stated in the bylaws and rules and regulations of every hospital. You should request and read these before you choose your hospital. Further you should commit to writing your understanding of the care you will receive from your physician and who will participate.

It’s your health. Take it seriously and protect it.