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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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2x Speed
12. Disagreements: Attending vs. Resident
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Medical practitioners are, in general, the most amiable companions and the best friends, as well as the most learned individuals I know.
~ Alexander Pope
Authority Clash
The Importance of Collaboration and Respect in Resolving Disagreements between Attending Physicians and Residents
The residents at County General Hospital had always respected their attending physician, Dr. Smith, for his knowledge, experience, and professionalism. However, recently, tensions had arisen between Dr. Smith and the residents over how to manage a particular patient. The patient, a young woman with a rare heart condition, had been under Dr. Smith’s care for several weeks, and the residents had been assisting him with her treatment. However, one of the residents, Dr. Patel, had disagreed with Dr. Smith’s diagnosis and treatment plan.
Dr. Patel felt that the patient needed a more aggressive approach to her treatment, while Dr. Smith believed that a more conservative approach was necessary to avoid further complications. Dr. Patel had tried to persuade Dr. Smith to change his mind, but the attending physician had refused to budge. As a result, Dr. Patel had taken it upon himself to change the patient’s medication, thinking that he knew better than Dr. Smith.
The patient’s condition worsened, and Dr. Smith soon discovered what had happened. He was furious with Dr. Patel and immediately reported him to the hospital administration. The hospital conducted an investigation, and Dr. Patel was ultimately found to have violated hospital policy by changing the patient’s treatment plan without authorization. He was suspended from his duties for two weeks and placed on probation for the rest of his residency.
The incident had a profound impact on the residents at County General. They realized that disagreements between attending physicians and residents were inevitable, but they also understood the importance of respecting the attending’s authority and following proper procedures for resolving disputes. They learned that effective communication and collaboration among the medical team were essential for providing the best patient care and that the ultimate responsibility for patient management rested with the attending physician.
In the end, the young woman with the rare heart condition recovered, but the incident had taught everyone at County General a valuable lesson about the importance of professionalism, respect, and teamwork in the practice of medicine.
Abstract
Healthcare is a collaborative effort that involves legal, institutional, professional, and evidence-based decision-making. Conflicts may arise in the patient-practitioner relationship due to different interpretations of facts, values, and priorities, but these disagreements should be resolved through respectful communication between the licensed practitioner and other medical providers. The ultimate responsibility for patient care rests with the licensed practitioner. If a disagreement may harm the patient, it may be necessary to bring the issue to higher levels of institutional policy for reporting. However, patients should not be informed about the disagreement, as this could damage their trust in the medical team. Residents must not practice medicine independently and must comply with the attending practitioner’s decisions.
**
Think
[12:1] Health care is an interprofessional activity requiring legal, institutional, professional, and evidence-based medical decision-making. As with all multi-individual decision-making, disagreements will arise because of many reasons, including: disagreements on what the objective facts are; disagreements on what the patient’s subjective goals, values, and priorities are; disagreements on what the proper treatment or amount of treatment should be; disagreements on what will maximize the patient’s best interests; and disagreements on what actions are morally permissible for a medical professional.
[12:2] Certainly, this is not a comprehensive list of possible categories of disagreements, but it shows that one must accept that various types of disagreements can and will occur as a matter of the human condition. The question that needs to be addressed is: what professional and institutional procedures need to be followed when a disagreement about patient management does occur?
Assess
Patient: 1) Autonomy
[12:3] The patient-practitioner relationship is between the licensed practitioner, i.e., the attending, and the patient. Confidentiality and privacy must be respected. If the patient with decisional capacity has autonomously provided informed consent giving the attending the authorization to provide treatment, then it follows that the resident, or others attending to the patient, in disagreeing with the attending, is in effect disagreeing with the patient’s decision. The resident has no authority to usurp the patient-practitioner relationship by discussing the disagreement with the patient independent of the attending. Rather, the resident should discuss the disagreement with the attending practitioner.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[12:4] The best patient care usually happens when an interprofessional team of medical providers work together and communicate effectively with each other towards the goal of maximizing the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, and through the effective implementation of the professional principles of beneficence (do good) and nonmaleficence (do no harm). Although patient care and management is a team activity, the ultimate responsibility and accountability lie squarely on the shoulders of the licensed attending practitioner. Therefore, if an attending practitioner disagrees with how the resident manages the attending practitioner’s patient, the attending should respectfully discuss the matter with the resident. Then the resident must legally, institutionally, and morally comply with the attending practitioner’s corrections. However, if a resident disagrees with how an attending practitioner manages his patient, then the resident should respectfully discuss the matter with the attending. However, in the end, the resident must comply with the attending’s decision, as it is the attending practitioner who is ultimately responsible and accountable for patient care.
[12:5] Certainly, there are times in which a resident may be correct in their assessment of mismanagement by an attending practitioner. If after the resident has had a respectful and thorough discussion with the attending, and if the disagreement may have a serious adverse effect on the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, then it is professionally incumbent on the resident to take the disagreement to the next level for further discussion. However, in the meantime, the resident must not change the patient management without the attending practitioner’s approval as the resident has no authority to make such decisions, has no authority to practice unsupervised medicine, and will be held legally, institutionally, and morally accountable for any harms that might occur to the patient due to the unauthorized changes in patient management.
Public Policy: 4) Justice
[12:6] If a serious adverse effect will occur to the patient without some intervention, even after having a respectful and thorough discussion with the attending, then institutional policy will direct the resident as to whom they should report the dispute. Generally, the resident would be obliged to bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair. It would be professionally inappropriate at this time to undermine the attending practitioner reputation by discussing the disagreement with other non-practitioner members of the medical team, and it would be inappropriate to discuss this discord with the patient independent of the attending as that could have an effect of diminishing the patient’s trust in the patient-practitioner relationship, and towards the interprofessional medical team.
Conclude
[12:7] It is not legal for a student to practice medicine without a license by making a medical judgment independent of the attending practitioner. If a resident disagrees with the attending practitioner’s patient management, then the resident must discuss this with the attending and not change the patient management without the attending’s authorization. At no time should the student or resident inform the patient about the disagreement; instead, the student or resident should have a respectful and thorough discussion with the attending practitioner. The same applies to other members of the care team.
[12:8] In summary, residents are not legally allowed to practice medicine independently and must discuss any disagreements with the attending practitioner. They should not change patient management without the attending’s authorization or discuss the disagreement with the patient, as this could damage the patient’s trust in the medical team. In cases where the disagreement may have serious adverse effects on the patient, institutional policy should guide the resident on how to report the dispute. Effective communication and collaboration among the medical team are essential for providing the best patient care.
**
12. Review Questions
1. Disagreements can and will occur as a matter of the human condition. For the practitioner, these disagreements consist of:
2. The resident has no authority to usurp the patient-practitioner relationship by discussing their disagreement with the attending practitioner with the patient.
3. Although patient care and management is a team activity, the ultimate responsibility and accountability lie squarely on the shoulders of the licensed attending practitioner:
4. The resident must not change the patient management without the attending practitioner’s approval as the resident has no authority to make such decisions, has no authority to practice unsupervised medicine, and will be held legally, institutionally, and morally accountable for any harms that might occur to the patient due to the unauthorized changes in patient management:
5. If a serious adverse effect will occur to the patient without some intervention, even after having a respectful and thorough discussion with the attending, then the resident would be obliged to bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair:
**
CORRECT! 🙂
[12:1] Patient health care is an interprofessional activity requiring legal, institutional, professional, and evidence-based medical decision-making. As with all multi-individual decision-making, disagreements will arise because of many reasons, some being: disagreements on what the objective facts are; disagreements on what the patient’s subjective goals, values, and priorities are; disagreements on what the proper treatment or amount of treatment should be; disagreements on what will maximize the patient’s best interests; and disagreements on what actions are morally permissible for a medical professional.
Wrong 😕
[12:1] Patient health care is an interprofessional activity requiring legal, institutional, professional, and evidence-based medical decision-making. As with all multi-individual decision-making, disagreements will arise because of many reasons, some being: disagreements on what the objective facts are; disagreements on what the patient’s subjective goals, values, and priorities are; disagreements on what the proper treatment or amount of treatment should be; disagreements on what will maximize the patient’s best interests; and disagreements on what actions are morally permissible for a medical professional.
CORRECT! 🙂
[12:3] The patient-practitioner relationship is between the licensed practitioner—the attending, and the patient. Confidentiality and privacy must be respected. If the patient with decisional capacity has autonomously provided informed consent giving the attending the authorization to provide treatment, then it follows that the resident, in disagreeing with the attending, is in effect disagreeing with the patient’s decision. The resident has no authority to usurp the patient-practitioner relationship by discussing the disagreement with the patient independent of the practitioner. Rather, the resident should discuss the disagreement with the attending practitioner.
Wrong 😕
[12:3] The patient-practitioner relationship is between the licensed practitioner—the attending, and the patient. Confidentiality and privacy must be respected. If the patient with decisional capacity has autonomously provided informed consent giving the attending the authorization to provide treatment, then it follows that the resident, in disagreeing with the attending, is in effect disagreeing with the patient’s decision. The resident has no authority to usurp the patient-practitioner relationship by discussing the disagreement with the patient independent of the practitioner. Rather, the resident should discuss the disagreement with the attending practitioner.
CORRECT! 🙂
[12:4] The best patient care usually happens when an interprofessional team of medical providers work together and communicate effectively with each other towards the goal of maximizing the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, and through the effective implementation of the professional principles of beneficence (do good) and nonmaleficence (do no harm). Although patient care and management is a team activity, the ultimate responsibility and accountability lie squarely on the shoulders of the licensed attending practitioner. Therefore, if an attending practitioner disagrees with how the resident manages the attending practitioner’s patient, the attending should respectfully discuss the matter with the resident. Then the resident must legally, institutionally, and morally comply with the attending practitioner’s corrections. However, if a resident disagrees with how an attending practitioner manages his patient, then the resident should respectfully discuss the matter with the attending. However, in the end, the resident must comply with the attending’s decision, as it is the attending practitioner who is ultimately responsible and accountable for patient care.
Wrong 😕
[12:4] The best patient care usually happens when an interprofessional team of medical providers work together and communicate effectively with each other towards the goal of maximizing the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, and through the effective implementation of the professional principles of beneficence (do good) and nonmaleficence (do no harm). Although patient care and management is a team activity, the ultimate responsibility and accountability lie squarely on the shoulders of the licensed attending practitioner. Therefore, if an attending practitioner disagrees with how the resident manages the attending practitioner’s patient, the attending should respectfully discuss the matter with the resident. Then the resident must legally, institutionally, and morally comply with the attending practitioner’s corrections. However, if a resident disagrees with how an attending practitioner manages his patient, then the resident should respectfully discuss the matter with the attending. However, in the end, the resident must comply with the attending’s decision, as it is the attending practitioner who is ultimately responsible and accountable for patient care.
CORRECT! 🙂
[12:5] Certainly, there are times in which a resident may be correct in their assessment of mismanagement by an attending practitioner. If after the resident has had a respectful and thorough discussion with the attending, and if the disagreement will have a serious adverse effect on the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, then it is professionally incumbent on the resident to take the disagreement to the next level for further discussion. However, in the meantime, the resident must not change the patient management without the attending practitioner’s approval as the resident has no authority to make such decisions, has no authority to practice unsupervised medicine, and will be held legally, institutionally, and morally accountable for any harms that might occur to the patient due to the unauthorized changes in patient management.
Wrong 😕
[12:5] Certainly, there are times in which a resident may be correct in their assessment of mismanagement by an attending practitioner. If after the resident has had a respectful and thorough discussion with the attending, and if the disagreement will have a serious adverse effect on the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities, then it is professionally incumbent on the resident to take the disagreement to the next level for further discussion. However, in the meantime, the resident must not change the patient management without the attending practitioner’s approval as the resident has no authority to make such decisions, has no authority to practice unsupervised medicine, and will be held legally, institutionally, and morally accountable for any harms that might occur to the patient due to the unauthorized changes in patient management.
CORRECT! 🙂
[12:6] If a serious adverse effect will occur to the patient without some intervention, even after having a respectful and thorough discussion with the attending, then institutional policy will direct the resident as to whom they should report the dispute. Generally, the resident would be obliged to bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair. It would be professionally inappropriate at this time to undermine the attending practitioner reputation by discussing the disagreement with other non-practitioner members of the medical team, and it would be inappropriate to discuss this discord with the patient independently of the attending as that could have an effect of diminishing the patient’s trust in the patient-practitioner relationship, and towards the interprofessional medical team.
Wrong 😕
[12:6] If a serious adverse effect will occur to the patient without some intervention, even after having a respectful and thorough discussion with the attending, then institutional policy will direct the resident as to whom they should report the dispute. Generally, the resident would be obliged to bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair. It would be professionally inappropriate at this time to undermine the attending practitioner reputation by discussing the disagreement with other non-practitioner members of the medical team, and it would be inappropriate to discuss this discord with the patient independently of the attending as that could have an effect of diminishing the patient’s trust in the patient-practitioner relationship, and towards the interprofessional medical team.
12. Clinical Vignettes
1. Mr. Neil Mohamed, a 68-year-old animator is admitted to the hospital with a complex medical condition that requires a multi-disciplinary approach. Medical practitioners have different opinions on managing patients during the patient's treatment. Which is the most appropriate way to resolve these disagreements between medical practitioners?
2. A resident works with a licensed attending practitioner at a hospital. One day, a 52-year-old female comes to the hospital with a complaint. The resident examines the patient and makes a diagnosis, but the attending practitioner disagrees with the diagnosis and orders different tests to be done. What should the resident do in this situation?
3. Mr. Joseph James, a 68-year-old economist presents to the emergency department with complaints of chest pain and shortness of breath, requiring a multi-disciplinary approach. The patient has a history of asthma but has not had an attack in several months. The patient's vitals are stable, but their oxygen saturation is low at 92% on room air. The licensed attending practitioner orders a 12-lead ECG and a chest X-ray, which reveal no acute abnormalities. Who is ultimately responsible and accountable for the patient's care and management?
4. A medical resident works in a busy hospital, rotating through various departments and gaining practical experience. One day, while on duty, the resident notices that a patient's condition has significantly worsened and decides to change the treatment plan without consulting the attending practitioner. The resident believes that a change in treatment is necessary to save the patient's life. What is the most important action the resident should have taken?
5. Ms. Carl Lewis, a 72-year-old retiree experiences a serious adverse effect. Despite the resident having a respectful and thorough discussion with the attending, the resident remains concerned about the patient's well-being and believes that some intervention is necessary. What should the resident do in this situation?
CORRECT! 🙂
Explanation: The scenario describes a situation where different medical practitioners have different opinions on managing a complex medical condition of a patient, which requires a multi-disciplinary approach. The most appropriate way to resolve these disagreements between medical practitioners is through respectful communication between the licensed practitioner and the other medical providers [12:1]. Effective communication is essential to ensure that all medical practitioners involved in the patient's care are aware of the treatment plan and that it is agreed upon by all [12:4]. This can be achieved through collaboration and respectful communication, where all the medical practitioners involved in the patient's care can share their opinions and expertise [12:4]. The option of discussing the disagreements with the patient to get their input is not appropriate in this situation as the patient may not have the necessary medical knowledge to make an informed decision [12:3]. The option of consulting with a supervisor to make the final decision may be appropriate in some situations, but it is not always feasible or necessary [12:6]. The option of avoiding discussing disagreements with other medical providers and making the final decision independently can lead to suboptimal care and should be avoided [12:4].
Wrong 😕
Explanation: The scenario describes a situation where different medical practitioners have different opinions on managing a complex medical condition of a patient, which requires a multi-disciplinary approach. The most appropriate way to resolve these disagreements between medical practitioners is through respectful communication between the licensed practitioner and the other medical providers [12:1]. Effective communication is essential to ensure that all medical practitioners involved in the patient's care are aware of the treatment plan and that it is agreed upon by all [12:4]. This can be achieved through collaboration and respectful communication, where all the medical practitioners involved in the patient's care can share their opinions and expertise [12:4]. The option of discussing the disagreements with the patient to get their input is not appropriate in this situation as the patient may not have the necessary medical knowledge to make an informed decision [12:3]. The option of consulting with a supervisor to make the final decision may be appropriate in some situations, but it is not always feasible or necessary [12:6]. The option of avoiding discussing disagreements with other medical providers and making the final decision independently can lead to suboptimal care and should be avoided [12:4].
CORRECT! 🙂
Explanation: The scenario describes a situation where a resident and a licensed attending practitioner have different opinions on the diagnosis and management of a patient. In this situation, the resident should comply with the attending practitioner's orders and work together to make a final diagnosis for the patient [12:4]. This is because the attending practitioner has more experience and expertise, and their input is valuable in ensuring the best possible care for the patient [12:4]. The option of refusing to comply with the attending practitioner's orders, is not appropriate as it can lead to suboptimal care for the patient and can also be considered insubordination [12:7]. The option of explaining their reasoning to the attending practitioner and trying to convince them to change their mind, is a good approach, but ultimately, the attending practitioner has the final say [12:4]. The option of contacting the hospital administration to discuss the disagreement between the resident and the attending practitioner, is not necessary unless the disagreement cannot be resolved through communication and collaboration [12:6].
Wrong 😕
Explanation: The scenario describes a situation where a resident and a licensed attending practitioner have different opinions on the diagnosis and management of a patient. In this situation, the resident should comply with the attending practitioner's orders and work together to make a final diagnosis for the patient [12:4]. This is because the attending practitioner has more experience and expertise, and their input is valuable in ensuring the best possible care for the patient [12:4]. The option of refusing to comply with the attending practitioner's orders, is not appropriate as it can lead to suboptimal care for the patient and can also be considered insubordination [12:7]. The option of explaining their reasoning to the attending practitioner and trying to convince them to change their mind, is a good approach, but ultimately, the attending practitioner has the final say [12:4]. The option of contacting the hospital administration to discuss the disagreement between the resident and the attending practitioner, is not necessary unless the disagreement cannot be resolved through communication and collaboration [12:6].
CORRECT! 🙂
Explanation: The scenario describes a patient with chest pain and shortness of breath, requiring a multi-disciplinary approach, and the licensed attending practitioner orders tests to help diagnose the condition [12:1]. In this situation, the licensed attending practitioner is ultimately responsible and accountable for the patient's care and management [12:4]. This is because the attending practitioner is the leader of the healthcare team and is responsible for coordinating the patient's care and making the final decisions regarding their management [12:4]. The other healthcare providers, such as the resident, respiratory therapist, and registered nurse, are responsible for carrying out the orders of the attending practitioner and providing their professional expertise and knowledge to ensure optimal care for the patient [12:4]. However, the attending practitioner is ultimately responsible and accountable for the overall care and management of the patient [12:4].
Wrong 😕
Explanation: The scenario describes a patient with chest pain and shortness of breath, requiring a multi-disciplinary approach, and the licensed attending practitioner orders tests to help diagnose the condition [12:1]. In this situation, the licensed attending practitioner is ultimately responsible and accountable for the patient's care and management [12:4]. This is because the attending practitioner is the leader of the healthcare team and is responsible for coordinating the patient's care and making the final decisions regarding their management [12:4]. The other healthcare providers, such as the resident, respiratory therapist, and registered nurse, are responsible for carrying out the orders of the attending practitioner and providing their professional expertise and knowledge to ensure optimal care for the patient [12:4]. However, the attending practitioner is ultimately responsible and accountable for the overall care and management of the patient [12:4].
Wrong 😕
Explanation: The scenario describes a medical resident who notices that a patient's condition has significantly worsened and decides to change the treatment plan without consulting the attending practitioner [12:7]. The most important action the resident should have taken is to notify the attending practitioner immediately and follow their orders [12:4]. This is because the attending practitioner is responsible for the overall care and management of the patient, and their experience and expertise can help ensure that the best course of treatment is followed [12:4]. The resident should have discussed their concerns and suggestions with the attending practitioner, and together they could have come up with the best course of action for the patient [12:4]. The option of proceeding with the change in treatment plan without informing the attending practitioner is not appropriate as it can lead to suboptimal care for the patient and can also be considered insubordination [12:7]. The option of contacting the patient's family members to seek their consent for the change in the treatment plan is not necessary in this situation, as the attending practitioner should be the first point of contact for any changes to the patient's treatment plan [12:4]. The option of consulting with a senior resident before making any changes to the patient's treatment plan can be helpful in some situations, but the attending practitioner should always be informed and involved in the decision-making process [12:4].
CORRECT! 🙂
Explanation: The scenario describes a medical resident who notices that a patient's condition has significantly worsened and decides to change the treatment plan without consulting the attending practitioner [12:7]. The most important action the resident should have taken is to notify the attending practitioner immediately and follow their orders [12:4]. This is because the attending practitioner is responsible for the overall care and management of the patient, and their experience and expertise can help ensure that the best course of treatment is followed [12:4]. The resident should have discussed their concerns and suggestions with the attending practitioner, and together they could have come up with the best course of action for the patient [12:4]. The option of proceeding with the change in treatment plan without informing the attending practitioner is not appropriate as it can lead to suboptimal care for the patient and can also be considered insubordination [12:7]. The option of contacting the patient's family members to seek their consent for the change in the treatment plan is not necessary in this situation, as the attending practitioner should be the first point of contact for any changes to the patient's treatment plan [12:4]. The option of consulting with a senior resident before making any changes to the patient's treatment plan can be helpful in some situations, but the attending practitioner should always be informed and involved in the decision-making process [12:4].
CORRECT! 🙂
Explanation: The scenario in question involves a serious adverse effect on a patient, which leads the resident to disagree with the attending practitioner [12:5]. The resident has a responsibility to advocate for the patient's well-being and to ensure that appropriate care is provided [12:4]. In this situation, the resident should bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair [12:6]. If the resident remains concerned about the patient's well-being, they should escalate the situation to the next level of institutional authority, to ensure that the best possible care is provided [12:6]. Ignoring the adverse effect and continuing to follow the attending's orders is not appropriate as it can lead to suboptimal care for the patient and can also be considered a violation of professional ethics [12:7]. The option of documenting the adverse effect and moving on to the next patient is not appropriate as the resident has a responsibility to ensure that appropriate care is provided to the patient [12:4]. Reporting the adverse effect to the nursing staff and hoping they will address it is not appropriate as the resident is part of the healthcare team and has a responsibility to ensure that appropriate care is provided to the patient [12:4].
Wrong 😕
Explanation: The scenario in question involves a serious adverse effect on a patient, which leads the resident to disagree with the attending practitioner [12:5]. The resident has a responsibility to advocate for the patient's well-being and to ensure that appropriate care is provided [12:4]. In this situation, the resident should bring the dispute to the attention of the next institutional level above the attending, such as the division head or department chair [12:6]. If the resident remains concerned about the patient's well-being, they should escalate the situation to the next level of institutional authority, to ensure that the best possible care is provided [12:6]. Ignoring the adverse effect and continuing to follow the attending's orders is not appropriate as it can lead to suboptimal care for the patient and can also be considered a violation of professional ethics [12:7]. The option of documenting the adverse effect and moving on to the next patient is not appropriate as the resident has a responsibility to ensure that appropriate care is provided to the patient [12:4]. Reporting the adverse effect to the nursing staff and hoping they will address it is not appropriate as the resident is part of the healthcare team and has a responsibility to ensure that appropriate care is provided to the patient [12:4].
**
12. Reflection Vignettes
1. Dr. Olivia Carter is a 28-year-old resident in training who has been working in the hospital for the past year. She is currently working with Dr. Jameson, an attending practitioner, on the medical-surgical floor. One of their patients is a 60-year-old man who was admitted with a bowel obstruction. The patient has a history of hypertension and has been taking medication to control his blood pressure for the past five years. Upon admission, the patient's blood pressure was high, and Dr. Jameson initiated treatment with an intravenous antihypertensive medication. However, Dr. Carter disagreed with Dr. Jameson's choice of medication and suggested an alternative medication that she believed would be more appropriate for the patient's condition. Dr. Jameson disagreed with Dr. Carter's suggestion and explained his reasoning for selecting the current medication. Dr. Carter continued to express her concerns to Dr. Jameson, but he maintained his position and decided to continue with the current medication. The patient's blood pressure improved, and he was scheduled for surgery to relieve the bowel obstruction. However, the patient's condition deteriorated after surgery, and he developed complications, including acute kidney injury and sepsis. Dr. Carter believed that the complications were related to the antihypertensive medication that was used, and expressed her concerns to Dr. Jameson. Dr. Jameson reviewed the patient's chart and agreed that the antihypertensive medication may have contributed to the complications. He acknowledged Dr. Carter's concerns and worked with her to adjust the patient's treatment plan to manage the complications. The patient's condition stabilized, and he was eventually discharged from the hospital with follow-up appointments to monitor his kidney function and blood pressure. Dr. Jameson and Dr. Carter discussed the incident and agreed to communicate more effectively in the future to ensure that patient care is optimized. This scenario highlights the importance of effective communication and collaboration among members of the healthcare team. It also illustrates the value of constructive feedback and the willingness to adjust treatment plans when necessary. Ultimately, the focus should always be on providing the best possible care for the patient, regardless of personal opinions or differences in approach.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Dr. David Delano is a 42-year-old attending practitioner who has been working at the hospital for the past ten years. He is currently working with Dr. Samantha Parker, a resident in training, on the medical-surgical floor. One of their patients is a 70-year-old woman who was admitted with pneumonia. The patient has a history of asthma and chronic obstructive pulmonary disease (COPD) and has been taking medications to manage these conditions. Upon admission, the patient's respiratory rate was elevated, and Dr. Parker initiated treatment with bronchodilators and corticosteroids. However, Dr. Delano disagreed with Dr. Parker's choice of medication and suggested an alternative treatment plan that he believed would be more appropriate for the patient's condition. Dr. Parker disagreed with Dr. Delano's suggestion and explained her reasoning for selecting the current medication.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
