150.998 Attending Physicians and Residents, Guidelines For:
MSSNY adopted the following statement as part of its official position. It is a supplement to the Guidelines for Attending Physicians and Residents Established by the New York Academy of Medicine. Because optimum care of hospitalized patients often entails technically sophisticated treatment modalities, reliance on the expertise of specialists and consultants, and frequent clinical assessments and judgments by house officers or other designees of the attending physician, it is imperative to specifically indicate the authority and responsibility for decisions about treatment and management. Ethically and legally, the patient’s freely selected attending physician possesses this authority and responsibility. Such action will strengthen the patient-physician relationship essential to the continuity of a patient’s care. The patient’s own physician clearly retains ultimate responsibility for patient management but close cooperation between his/her own physician and the involved house officers and specialist consultants is essential to provide the highest quality of patient care. Features of this cooperation should include at least the following:
(1) Ongoing discussions and review of the patient’s course by the attending and other involved physicians.
(2) Explicit approval and/or supervision by the amending of invasive, hazardous, or complex diagnostic or treatment procedures.
(3) Explicit approval by the attending physician of the indications or requests for consultations, and of the choice of consultant.
(4) Recognition by the attending physician to contribute to the education, training and learning experience of the house staff.
(5) Conscientious efforts by the house staff and other involved physicians prompted to inform the attending physician of unexpected changes in the patient’s condition or needs for treatment.
(6) Although there is recognition by both attendees and house officers that they share responsibility for writing orders, recording observations, or formulating analyses or treatment goals in the progress notes, the ultimate authority for patient care is the patient’s attending physician.*
These guidelines will best serve the goal of optimum care for the patient and will enhance the quality training for young physicians. The attending physicians, hospital administrations, and house officers have the obligation to respect these guidelines and the attending physician shall candidly inform the patient of the roles of the various physicians in that patient’s care. In such explanations, the patient’s right freely to select his/her own physician must be maintained. No assignment of attending physician shall be made without prior discussion of available options with the patient and then only with his/her full knowledge and freely given consent. (HOD 1982-51; Reaffirmed HOD 2013; Reaffirmed HOD 2023)
The Guidelines of the New York Academy of Medicine are available, upon request, at the Society Headquarters in Westbury.
NB: Per General Counsel, this position statement was cited in the dissenting opinion in Somoza v. St. Vincent’s Hospital 596 N.Y.S. 2d 789 (App. Div., 1st Dept., April 22, 1993). The majority decision nevertheless held that a hospital and a hospital resident may be held legally responsible where the hospital resident carries out the order of a private attending physician but knows, or should know, that the physician’s orders “are so clearly contraindicated by normal practice that ordinary prudence require inquiry into correctness of the order.” The ruling, according to the majority decision, is an exception to the general rule followed by the courts which holds that the hospital and the hospital staff cannot be held legally responsible for the actions of a private attending physician as long as the hospital staff properly carries out the attending physician’s orders. (Reaffirmed HOD 2024)
