In 1949, the phrase “captain of the ship” was used to justify Pennsylvania Supreme Court’s verdict of McConnell vs. Williams, where obstetrician Dr. Williams was found guilty of negligence in blinding a newborn even though he was not directly involved in the encounter. The intern who was working with Dr. Williams at the time had incorrectly administered silver nitrate eyedrops to the infant, yet Dr. Williams was found to be guilty and not the intern because he, as the physician, was “captain of the ship” and therefore responsible for the actions of his “crew.”
In the decades since this case, myriads of changes have taken place regarding the legality of who is responsible for detrimental medical outcomes. For the most part, courts have come to recognize the complexity of medical practice, which precludes one individual from being able to have complete control over a patient’s medical care.
With interprofessional education gaining momentum and the complexity of patient care, especially for patients who may need the most care, increasing, there is a strong push towards team-based decisions rather than individual ones.
So the question remains: should a physician still remain “captain of the ship?”
I believe the short answer to be “yes.” With, of course, some caveats.
(As an aside, I’m not talking about the seemingly ubiquitous “physicians have the longest training” argument. Imagine if a newly-minted attending physician works with a team of nurses, physical therapists, and social workers who have been in practice for over thirty years. Would their experience and expertise not be considered “more training” in this case? I hope to focus on a few alternative points. Allow me to elaborate.)
Difficult, life-changing, and risky medical decisions come with the territory of medicine. Regardless of practice, expertise, training, or experience, there are rarely right answers, especially in uncharted territories of patient-physician matchups. There must be a leader to navigate the uncertain waters towards the best option when there is no right answer.
The caveat is that these answers should not be made alone or in isolation based on a hierarchy of pre-ordained responsibilities designated solely by title.
I should then modify the above statement to: There must be a leader to navigate the uncertain waters towards the best option and call upon others to gain more knowledge of what may be the best route when there is no right answer.
I believe that physicians, who are trained in so many considerations of the human body and mind, should recognize their own strengths and weaknesses. But one of the strengths of the physician is the ability to scope the human body molecularly, anatomically, physiologically, and the-phenomena-we-can’t-explain-yet-ly. This equips the physician to recognize and call upon the expertise of other healthcare professionals to discuss or reinforce treatment approaches.
The ultimate focus should be on altering the definition and expectations of the captain, rather than worrying about the hierarchical formalities of the title. Instead of expecting the captain to take responsibility for failures (by which reasoning means that the physician should take responsibility for successes as well), it is much more important to expect this “captain” to facilitate a leadership style of openness and thoughtfulness, as well as garnering multiple interprofessional opinions before making a difficult decision.
After all, the Pennsylvania Supreme Court agreed in 1949 that there is indeed a “crew” when it comes to the medical care of patients (the ship). And whether the ship sinks or sails is a result that affects all members of the crew, and thus their opinions should contribute meaningfully to the captain’s decision.
Interdisciplinary Team Issues. University of Washington. April 11, 2008. https://depts.washington.edu/bioethx/topics/team.html
Don’t Go Overboard: Limited Use of the Captain of The Ship Doctrine. McCumber Daniels: Firm News. 2017. http://www.mccumberdaniels.com/firm-news/attorney-articles-and-commentaries/dont-go-overboard-limited-use-of-the-captain-of-the-ship-doctrine.aspx
TONSIC Et Vir. v. Wagner. Justia. 2017. https://law.justia.com/cases/pennsylvania/supreme-court/1974/458-pa-246-0.html
Maggie Xiong is a medical student in The University of Arizona College of Medicine – Phoenix, Class of 2021. She graduated from the University of California, Berkeley, with a degree in Asian studies before taking a winding road to medical school. Maggie tries too many new restaurants (and subsequently Yelps about them), often cleans when she should be studying, and has a hopeless habit of opening too many tubes of mascara at once.