RESIDENTS ETHICAL DISAGREEMENTS WITH ATTENDING PHYSICIANS - AN UNRECOGNIZED PROBLEM

Purpose. To evaluate the frequency and nature of ethical disagreements over patient care between housestaff and attending physicians. Method . During the spring of 1994, a cross-sectional survey about ethical di sagreements was conducted of all 42 internal medicine housestaff at th e West Virginia University Hospitals and all 51 faculty in the Departm ent of Medicine at the West Virginia University School of Medicine, Ch i-square analysis was used to compare categorical variables. Results. Thirty-six (86%) of the residents and 41 (80%) of the faculty responde d. The housestaff recounted 121 ethical disagreements between attendin g physicians and housestaff in the previous year; the attending physic ians reported 19. A total of 32 residents reported at least one ethica l disagreement with an attending physician during the previous year. W hen asked about their most troubling disagreement, 27 (84%) of these r esidents reported they had been distressed because they considered the treatment ordered by the attending physician to be futile. Only 11 re sidents (34%) had discussed their most troubling disagreement with the attending physician. Of the 24 residents who correctly identified tha t a formal process to resolve ethical disagreements with a physician d id not exist, 17 desired one. Conclusion. The residents' disagreements with attending physicians over ethical aspects of patient care were c ommon and usually concerned issues of overtreatment. Since most of the housestaff did not express their concerns, the attending physicians w ere largely unaware of them. The findings suggest that residency direc tors need to encourage housestaff to discuss their ethical conflicts w ith attending physicians.