| This does pose a sort of chicken-and-egg problem for residents, although I would hesitate to call it a bait-and-switch. In a vacuum, everyone would choose the best care available to them. Of course this is expected. How can anybody be expected to do otherwise when it's their life (or family member's) at stake? Atul Gawande talks about this experience in Complications: A Surgeon's Notes on an Imperfect Science [0], where his son had been cared for by a full team of cardiologists, ranging from fellows in specialty training to attendings who had practiced for decades. However, due to certain complications, they needed to choose a pediatric cardiologist with which to schedule follow ups and decide on what procedures would be necessary in the future. One of the fellows, who had been the one putting most of the time in caring for his son, proactively approached them the day before discharge and suggested setting up an appointment. It's common for fellows to receive patients this way, and at any teaching hospital, an attending is there to supervise and take over if needed. The entire system is set up such that residents and trainees are given opportunities to learn. He says: > A resident intubated him. A surgical trainee scrubbed in for his operation. The cardiology fellow put in one of his central lines. None of them asked me if they could. If offered the option to have someone more experienced, I certainly would have taken it. But that was simply how the system worked—no such choices were offered—and so I went along. [...] > The advantage of this coldhearted machinery is not merely that it gets the learning done. If learning is necessary but causes harm, then above all it ought to apply to everyone alike. Given a choice, people wriggle out, and those choices are not offered equally. They belong to the connected and the knowledgeable, to insiders over outsiders, to the doctor's child but not the truck driver's. If choice cannot go to everyone, maybe it is better when it is not allowed at all. [0] https://www.goodreads.com/book/show/4477.Complications |
Juniors have to learn somewhere. The reality - in Australia, at least - is that juniors learn in the public system where patients don't really have a choice.