Expectations of groups versus pairs of attendings and residents about phone communications and bedside evaluation of hospitalized patients.

BACKGROUND: Residents covering attendings' patients must decide when to call the attending and when to evaluate patients at the bedside for new clinical events. Conflicts arise when residents and attendings disagree about these decisions.
PURPOSE: Our purpose was to determine differences in expectations between attendings and residents concerning the need for phone communication about, and bedside evaluation of, new patient problems in hospitalized patients.
METHODS: Teaching attendings and categorical medical residents rated a series of 15 clinical vignettes regarding the importance of phone communication about the problems depicted in the vignettes and rated a second series of 9 vignettes about the need for bedside evaluation of problems depicted.
RESULTS: Mean Likert scores were similar between residents and attendings for 70% of the scenarios. When analyzed for disagreement within hypothetical resident/attending pairs, the survey revealed that disagreement would be expected to occur as often as 33% of the time for phone communication and up to 43% of the time for bedside evaluation. Attendings disagreed with each other 41% of the time. Residents were less likely to say they would call attendings at night than attendings wanted to be called (odds ratio=0.74, p=.04).
CONCLUSION: There was substantial disagreement among hypothetical resident--attending pairs regarding need for phone communication and bedside evaluation. Residents and attendings need to discuss their expectations regarding these issues to avoid conflict.