To The Editor:
I was very heartened to read "Ethics in Practice. Residency
Training" (82A: 1356-1357, Sept. 2000), by Capozzi and
Rhodes. When I left my residency twelve years ago, these types of
things were not really even discussed. It is nice to see them addressed
in print. I think that, in an ideal world, and in a private hospital
setting, these ideas of how things should be handled would probably
work very well. However, in county hospitals and in VA hospitals
across the country, residents are being supervised only by chief
residents; more often than not, the attending surgeon on the case
is across town at the private hospital, and he or she is the attending
on record only and not in fact. There are also hospitals in this
country where the attending surgeon watches the surgery on a video
monitor. I have also heard in the last few years that the
residents are still being told that asking for help is a sign of
weakness, so I believe very firmly that a lot of work needs to be
done vis-à-vis the ethical issues of residency training.
Another thing that concerns me, although the article doesn’t
deal with it, is that over the years I have repeatedly seen an attending
surgeon stand up at a major meeting and say: "Well, we
have a higher complication rate and it is because we have residents." I
feel that this type of comment serves one purpose and one purpose
only: to convey the message to residents that it is always somebody
else’s fault when something goes wrong. I think that this
is something that probably needs to be addressed.
I do, however, congratulate you on the tenor of the article in
the September issue of The Journal.
—Beth M. Dollinger, MDElmira Orthopaedic
Associates
722 West Water Street
Elmira, NY 14905