The Case

A 42-year-old woman presenting to an academic medical center with low back pain radiating down her left leg was deemed to be a good candidate for a lumbar epidural steroid injection after undergoing a thorough evaluation. The procedure along with all the possible attendant side effects were thoroughly explained to the patient who readily signed the consent form. The patient was prepped and positioned, but, upon seeing that a resident rather than her attending doctor would be doing the procedure, she objected, insisting that the attending do the procedure. The attending explained that she was in a teaching hospital, where residents commonly do procedures under close supervision of attending physicians. Nevertheless, the patient still insisted on whom she wanted to do the procedure and became visibly agitated. How do you accommodate the training needs of medical students, residents, and fellows while maintaining adequate care for patients? Does the "see one, do one, teach one" principle commonly practiced in academic settings compromise the bioethical principles of nonmaleficence and beneficence? What should the attending do in this case with the patient on the table? What are the patient's rights here versus the needs of the training setting?