By: Robert Underhill
One of the lesser understood aspects of the medical world by patients is that of student shadows that may be encountered in medical offices and hospitals, including in the OR and ER. They could be 9th graders who hope to be a physician someday, 3rd year medical students who are close to achieving that goal, or anywhere in-between. Shadowing is an educational tool for the student. It is also something many medical schools look for applicants to have done.
So what’s the problem? Informed consent. Each physician and hospital is deciding for themselves what constitutes informed consent. There is not a consistent protocol.
Ideally the patient is asked if it is OK to have a shadow present, told what their educational status is, and introduced to the student. This is informed consent. Some physicians do it that way and the patient says yes or no as is their right.
The other end of the spectrum is when patients don’t even know they had student observers in the OR. Most consent forms have the word “student” buried in small type somewhere on it. The problem is few patients ever read the form. Instead they rely on the physician or nurse who tells them it allows them to do the procedure and to bill their insurance. There is no mention that the form authorizes anything else. Often the forms are handed to patients very shortly before surgery and after their glasses have been taken with a nurse pointing to where they want the patient to sign. That’s not informed consent.
Sometimes the patient is told rather than asked that the student will be observing. Many patients don’t know that they can say no. That’s not informed consent.
Sometimes the student is introduced as a student doctor which to most patients infers being in medical school. The student might actually still be in high school. That’s not informed consent.
There are physicians who don’t introduce the student as a student but rather give them a white physicians jacket and walk into the room saying “This is Mary. She’ll be assisting me today”. Of course she’ll observe rather than assist, but the patient has been led to believe the student is actually a medical professional nonetheless. That’s not informed consent.
So why is informed consent not the norm?
Some physicians and hospitals think because the student is just observing that it shouldn’t matter to the patient if they are there, especially in OR settings where the patient is anesthetized and would be unaware of their presence.
Some see the benefit to the student as outweighing the patient’s right to make an informed choice.
So why is this an issue worth drawing attention to?
Some patients don’t want any extra eyes in the room. Some might be willing to help a medical or nursing student with their education but not anyone else.
Some would decide based on the procedure being done. The patient who is OK with 14-year-old opposite gender student watching stitches be taken out on a finger may not be OK with that same 14-year-old watching them be catheterized. Some physicians do restrict student shadows in this regard, others impose no restrictions.
True informed consent for student shadow presence should be standard practice, yet it is not.
ABOUT THE AUTHOR:
Robert Underhill is a retired executive living in Vermont. More importantly, he is a husband, father, and grandfather. His goal is to raise awareness to the lack of attention paid to men’s modestly and hopes to achieve gender parity throughout all levels of the healthcare team. We sincerely wish more men will add their voices to this very important yet neglected topic.
Photo credit: http://medicalschoolhq.net/how-to-effectively-shadow-a-physician-as-a-premed-student/
© 2017, Linda Girgis MD. All rights reserved.