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/
Copyright secured by Digiprove © 2017 Linda Girgis, MD, FAAFP
Hi everyone, I’ve written about this issue many times for Dissident Voice and KevinMD. If there was a poll taken amongst American physicians, and they were asked whether the patient should be given a choice vis-a-vis the presence of observers, I’m sure the overwhelming majority would answer in the negative. Just read the comments that follow this article I wrote on the subject for KevinMD: https://www.kevinmd.com/blog/2017/11/physician-shadowing-immoral.html.
The problem is that doctors have realized that if there is a third person in the room during a patient’s office visit, this arms them with a critical protection against accusations of impropriety. Many doctors would rather have this legal protection than defend patient privacy.
Another problem is that there are many teaching hospitals where it has simply become the norm for the attending to saunter into an examination room with a medical student, resident, or even an entire entourage in tow. For these people, “teaching the younger generation” is far more important than patient privacy, consent, dignity, and confidentiality.
This is another article I recently wrote on the subject: https://dissidentvoice.org/2018/06/when-health-care-is-a-privilege-and-physician-shadowing-is-a-right/
In the last part of the article it said that a patient my be fine with a 14 year old of opposit gender shadowing a doctor taking stitches out but not good with a catheter being put in. We’ll no kidding, who is going to be fine with that!!!! That had to have been said as a joke, it can’t be serious. I believe in all states there is a child victim crime somewhere in that where adult nudity is involved. I believe you can’t involve children under the age of 17 in situations like that. I believe that the shadowing needs a real good hard looking at and drastic chages made before somebody in the medical field, male or female gets a good long prison term.
Had this situation 3 days ago with a very young, male “student” entering with the doc without my consent for a DRE and frontal exam. Had he actually assisted I might feel it was an uncomfortable contribution to medicine.
Next time I hope to be able to decide who is present for my compromised situations.
Were you even told what kind of student he was? High school? College? etc.
No. He followed the doc in. Missed his the name too. I did withhold info until the doc sent him out to retrieve copies. When he left I disclosed info the doc should know but I didn’t want the student knowing. I’ll tell the doc this on next appt.
Many, many thanks to you, Doc Linda for bringing a voice to many men.
I think it is an important topic to discuss. Thanks for your comments!
Ka,
You are always able to say who you want or don’t want in the exam room with you. Anytime that you’re not good with something, speak up and change the situation. You’re paying for a service so you have the say of what will take place during an exam.