A resident or fellow's dilemma: a medically incorrect order by a direct clinical supervisor

The relative medicolegal responsibilities of residents or fellows versus attendings in the care of service patients have been well studied, but the subject of how a resident or fellow can protest or refuse an order believed to be medically wrong or contraindicated is unstudied and unknown. Two cases are reported in which a gastroenterology fellow was ordered by an attending to perform or assist in invasive procedures believed to be either contraindicated because of patient instability or unambiguously not indicated according to established procedure guidelines. These two novel cases highlight the dilemma encountered by a resident or fellow with regard to obeying an improper order to avoid complaining about an attending versus disobeying such an order to comply with the Hippocratic Oath of doing no harm. Although the reported cases involved gastroenterology fellows, this type of problem can occur during any medical residency or fellowship. These case reports suggest the need for a hospital-based administrative policy and mechanism to resolve such conflicts fairly, without confrontation, resident intimidation, or career consequences.