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June 16, 1993

House Staff Work Hours, Supervision, and Quality of Care-Reply

JAMA. 1993;269(23):2988. doi:10.1001/jama.1993.03500230069030

In Reply.  —Drs Friedmann and Griffen and, unfortunately, others have confused continuity of care with handoff or signout. Continuity of care is the responsibility of the attending physician. Handoff or signout is an important part of medical practice. While many attending physicians work long hours, all of them at some time will arrange for someone else to assume their responsibility for the patient. My Editorial cited by Friedmann and Griffen clearly notes that "[t]he Bell Committee report emphasizes that the responsibility for the patient lies with the attending physician." If because of a change in the working conditions of residents the number of handoffs or signouts are increased, and if the attending physician considers this deleterious to the care of the patient, then it is up to the attending physician to be certain that potentially adverse events do not occur. My Editorial notes that "the public does not hire or