When a resident and an attending physician disagree, the attending has the right to overrule the resident. But both should talk openly about the issue. During one 28-hour call shift, I took care of a critically ill man in the cardiac intensive care unit. He had been sick for years, and had been getting worse over several months. It was a relatively quiet night, so I was able to spend a lot of time in his room. I watched him become increasingly confused and sleepy, his skin become mottled with net-like patches, and his blood pressure fall lower and lower despite adding multiple medications to keep it up. All of these were signs that he was close to death, and there was little chance he would get better.

By encouraging dissenting opinions, attending physicians can foster richer conversations about important decisions.

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