Bell, Bernard M. "Greenhorns in White," New York Times, 9 February 1995, p. A23.

 

Bell, Bernard M. "Greenhorns in White," New York Times, 9 February 1995, p. A23.

If you go into the hospital and see a young man or woman in white, you are likely to address him
or her as "doctor." Therein lies a big problem.

Often these people are not really doctors, at least in the sense the public understands:
experienced, board-certified physicians and surgeons. They are graduate medical students. Some
are interns, often fresh out of medical school the previous July. Others are residents who have
been at the hospital two to four years.

These people should not be taking on total responsibility for the care of patients and should not
be making independent decisions about their care. That is solely the province of the attending
physician - someone who has been appointed to practice medicine in that hospital.

This week New York Hospital was absolved in the case of Libby Zion, the young woman who
died there in 1984 after a resident gave her the wrong drug. But regardless of legal liability, the
trial made clear that too much responsibility is being vested - dangerously - in interns and
residents.

When attending physicians are far too busy, or live too far away, to supervise young interns and
residents who are overseeing their patients - a standard situation - then it is the hospital's duty to
have a physician on the premises at all times who is equal in experience to the attending doctor.
Far too often, this duty is honored only in the breach.

The requirement for an on-premises attending doctor who must be called by the house staff was a
recommendation made in 1987 by the state's Ad Hoc Committee on Emergency Services (the
Bell Commission, of which I was chairman). Our mission was to respond to a grand jury report
that suggested that Ms. Zion's death might have been prevented by close supervision. That
recommendation became law, but it is being widely flouted for economic reasons: interns and
residents, who are being educated on the job, are too frequently exploited as cheap labor.

In the Zion case, the jury treated the interns and residents as if they were equal to the attending
doctor in wisdom and experience. The intern had graduated from medical school only 9 months
earlier, the resident 21 months earlier. Both their teacher, who was the attending physician, and
New York Hospital were parties to this absurdity.

This made both neophytes party to the malpractice suit - a position they should never have been
put in. Only attending physicians and institutions should bear consequences of what the medical
establishment euphemistically calls "adverse medical events."

The apparent confusion of the jury and the public in considering interns and residents as mature
physicians is a major problem that needs a major solution. Patients pay a lot of money to
attending doctors; they don't pay anything to interns and residents, because they do not hire
them.

The best way to set things straight is to delay granting the M.D. degree, now given at the end of
four years, until the end of residency, typically seven or either years. It is at this point that young
doctors are qualified to take the various board examinations. When they pass those rigorous
examinations, they can become qualified practicing physicians.

- - - - - - - -
Bertrand M. Bell, professor of medicine at the Albert Einstein College of Medicine of Yeshiva
University, is an attending physician at the Bronx Municipal Hospital Center.