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Opinion 9.055 - Disputes between Medical Supervisors and Trainees

Clear policies for handling complaints from medical students, resident physicians, and other staff should be established. These policies should include adequate provisions for protecting the confidentiality of complainants whenever possible. Confidentiality of complainants should be protected when doing so does not hinder the subject’s ability to respond to the complaint. Access to employment and evaluation files should be carefully monitored to remove the possibility of tampering. Resident physicians should be permitted access to their employment files and also the right to copy the contents thereof, within the provisions of applicable federal and state laws.

Medical students, resident physicians, and other staff should refuse to participate in patient care ordered by their supervisors in those rare cases in which they believe the orders reflect serious errors in clinical or ethical judgment, or physician impairment, that could result in a threat of imminent harm to the patient or to others. In these rare cases, the complainant may withdraw from the care ordered by the supervisor, provided withdrawal does not itself threaten the patient’s immediate welfare. The complainant should communicate his or her concerns to the physician issuing the orders and, if necessary, to the appropriate persons for mediating such disputes. Mechanisms for resolving these disputes, which require immediate resolution, should be in place. Third-party mediators of such disputes may include the chief of staff of the involved service, the chief resident, a designated member of the institutional grievance committee, or, in large institutions, an institutional ombudsperson largely outside of the established hospital staff hierarchy.

Retaliatory or punitive actions against those who raise complaints are unethical and are a legitimate cause for filing a grievance with the appropriate institutional committee. (II, III, VII)

Issued June 1994 based on the report "Disputes Between Medical Supervisors and Trainees," adopted December 1993 (JAMA. 1994;272:1861-65).