number of factors. Principally, the trainee is in a position of weakness regarding both knowledge and experience. The feeling that there is a wrong approach to a problem can be difficult to articulate under any conditions. When confronted by a summary of the literature, however recent, or simply by the senior surgeon’s experience, it may be nearly impossible to engage in honest debate. However, the trainee’s exposure to multiple attendings, and even multiple institutions, may provide a more up-to-date, thorough review of possibilities. Of course, the trainee also has a social consideration; the attending has the power of the evaluation. In the hierarchy that is a surgical team, there may be a fine line between perceived debate and insubordination. Under the best of conditions, there is a relationship between those of different levels of experience, which makes the communication easy. However, a clash over a single patient encounter may tarnish the relationship and may cloud patient care issues with personal conflict. Fortunately, the simpler the problem, the simpler the resolution. “Because I said so” is an effective means of justifying slight variations from the routine delivery of care. However, there are situations when a trainee may feel that a procedure is being withheld or that the effective therapy is being misapplied. The first role of the trainee in this instance is to question the authority. There is no substitute for direct question and answer. It may be that the attending has a strong reason, which becomes obvious through a few moments of discussion. However, should that fail to clarify matters for the trainee, it can rapidly reach the point of conflict. What typically happens is some degree of acceptance. What the attending surgeon wants, the attending usually gets. Ultimately, this is just, as the legal responsibility for the care of the patient rests Do the right thing. It is an easy phrase to say and even easier to remember. You would have probably heard it countless times. It is a catchphrase. It is a movie. It is even a bumper sticker. Yet in the realm of surgical judgment, the right thing may not be the obvious course of action. The care of surgical patients in difficult cases is highly nuanced and not readily reduced to discrete algorithms. As a trivial example, the “right” antibiotic for a young woman may be exactly the “wrong” antibiotic if she is pregnant. Judgment extends well beyond the routine, day-by-day choices we make in the postoperative period. The nuances of determining whether someone deserves an operation and the timing of that intervention can take a full surgical lifetime to master. This is widely acknowledged and universally accepted by the surgical community. We place substantial emphasis on the thought process behind operations and not just on the technical aspects of surgery. For example, every week we enjoy a morbidity and mortality conference, and each surgeon sits in front of a jury of peers during the oral board certifying examination. Clearly, as a group, we value good decision making. So what do trainees do when they feel that the surgical attending is doing the wrong thing? This is a complex issue but one sure to face every student, resident, or fellow. It is complicated by a Surgical Innovation Volume 15 Number 1 March 2008 74-75 © 2008 Sage Publications 10.1177/1553350608316670 http://sri.sagepub.com hosted at http://online.sagepub.com Editorial