“Pretend you didn't hear that”–managing ethical dilemmas from the bottom of a medical hierarchy

Abstract

Joe Hopeful, a third-year medical student, is on his dermatology rotation. He is planning to apply in the field, and he hopes to receive a letter of recommendation from a well-known surgical attending, Dr Malaprop. A visiting female postgraduate year-3 dermatology resident interviews for a Mohs micrographic surgery fellowship position during Joe’s rotation. One afternoon, Joe overhears the current fellow asking the attending what she thinks of the applicant. Dr Malaprop responds by saying ‘‘the applicant has an impressive resume; however, she recently had a baby, and I have hesitations over whether she can fully commit to the fellowship. A couple years ago, I made a mistake by taking on a fellow who was a new mother. I can’t afford to do that again.’’ Noticing Joe in the corner, Dr Malaprop turns to him and says, ‘‘Pretend you didn’t hear that.’’