The authors (1) deserve applause for bringing up a practical and important deficiency in current medical practice. The incidents narrated by Aggarwal et al appear to follow poor inter-personal relationships between the various clinicians, the need for one or more of them to dominate over others, and sheer cussedness. They may also be the consequence of overwork with little opportunity to relax and shed exhaustion. Whatever the reasons, the patient suffers as a consequence and may worsen or even die, as doctors war over turf or massage their egos.

I’m afraid one of the solutions offered by the authors – the creation of guidelines – may not work. How many guidelines are administrators expected to formulate? Can they ever cover every possible situation that can arise in day-to-day work with patients? Besides, there already exists an over-arching guideline that must serve all doctors: "First of all, do no harm." Enunciated by Charaka and Susruta in our country and Hippocrates in Greece, it embraces all possible situations, is simple and keeps the patient’s best interests in mind.

The administration has an important role to play. Every infraction of this guideline should invite action to ensure that there is no repetition. The judicious use of punishment – not by the administration but by a body of peers from among the respected staff members in the clinical fields – will help. Habitual troublemakers need special attention and if recalcitrant, dismissal. Punishment, alone, however, may prove counterproductive. Cussedness views punishment with disfavour and will only prompt more subtle forms of dispute or the use of subterfuge and diversionary tactics.

Far better would be the welding of the entire clinical team into a harmonious unit through the use of education and judicious rewards. Education in the principles of medical ethics and the humanities may prove especially effective in the long run. It is equally important to get to the root causes for the display of anger and frustration and address them. If overwork and exhaustion are noted, the administration should modify work schedules to ensure that no resident doctor is denied the hours of rest and recreation that are his due.