Graduated Patient Responsibility

Abstract

To the Editor.— I found it difficult to believe that the Patient approach described by Grace et al (231-351,1975) is really designed to foster a maximum learning experience for the physician. Having taught at all levels for many years, I am fully in favor of careful supervision in all cases, but this need gradually decreases as knowledge and experience increases. Eventually, supervision becomes somewhat more involved with complex or difficult case problems. In my opinion, the psychological key to Graduated Physician Responsibility is represented by an increasing assignment and full designation for minor and even major decisions as the physician's capacity warrants. The realization that in every case one's orders or decision will be screened immediately by one above oneself, and in a few hours by one above him, and the next morning by the chief of medicine and the attending physician, with the latter then to be