A Medical Student and YOU: The Matter of Honesty
I am putting up a series of excellent discussions about ethical/professional issues that could involve a medical student and you or a family member as a patient. Each discussion as a separate thread is based on the book Professionalism in Medicine : A Case-Based Guide for Medical Students. Cambridge:Cambridge University Press; 2010 and from the website "Professionalism in Medicine" prepared by Jefferson Medical College in Philadelphia Pennsylvania. Each issue at the website is begun with a brief vignette, and then a brief video dramatization of the vignette and then followed by perspective commentaries by a medical student and followed by that of a faculty member. First go to the following link, read, view and then return and present the visitors to this thread your own view of the particular professional issue from the perspective of the patient: Commitment to Honesty with Patients.
A STARTING COMMENT FROM ME:
Honesty with the patient or family requires that those who are called "doctors" are indeed "doctors" and not medical students who haven't graduated. As I have written on a much earlier thread, I totally disagree with the identification of the student as even a "student doctor" as I also disagree with the term "student nurse". I think all those who interact with a patient should be identified as to their role. This is part of being honest with the patient. So let's call the students what they are: "nursing student" and "medical student"--- NOT a nurse and NOT a doctor. ..Maurice.
posted by Maurice Bernstein, M.D. @ 2:44:00 PM
8 comments
8 Comments:
Honesty with the patient or family requires that those who are called "doctors" are indeed "doctors" and not medical students who haven't graduated. As I have written on a much earlier thread, I totally disagree with the identification of the student as even a "student doctor" as I also disagree with the term "student nurse". I think all those who interact with a patient should be identified as to their role. This is part of being honest with the patient. So let's call the students what they are: "nursing student" and "medical student"--- NOT a nurse and NOT a doctor. ..Maurice.
While this scenario is fictional, this crap goes on daily countless times across the country. There are so many aspects of this case that are ethically, morally, and legally (IMO) wrong!
The mere fact that a resident would place a student's training before the health and welfare of an infant is chilling.
The student is not even an intern; has not graduated from medical school correct? Its one thing for an adult to agree to a third year student participating in their healthcare but never an infant, especially with real risks involved, regardless of the percentages.
How can a resident encourage this? Where is the resident's supervisor in this process. Student Doctor Green?
Tells the parents Dr Green will do the procedure! Informed Consent means just that. While the parents may be informed, the consent aspect is clearly missing.
People walk into clinics and hospitals daily throughout the country totally ignorant of the medical culture which apparently views mere mortals as some lower life form.
Until there are uniform ethical and moral standards nationwide with teeth, this crap will continue.
Disgusting and reprehensible!
Ed
Ed, to me it is referring the 3rd year medical student as "Doctor Green" to the parent is the point that troubles me as dishonesty. If the resident feels assured that the student, with his help, can safely perform the puncture, then this should be told to the parent but after identifying the medical student as a "medical student".
At the moment, as a teaching tool, consideration should be given to the future value of this one lumbar puncture on an infant to the medical student at this point in her training. It probably be more of value for her to watch and learn but to actually continue her first attempts on a cooperating immobile adult rather than a potentially squirming baby. ..Maurice.
My apologies for my tone but where is the true supervising physician who is supposed to supervise the resident? Does the father know he is dealing with a resident and not the physician who is truly responsible for the care his child receives?
Many times patients, or in this case, the father, implicitly and blindly trust that the "physician" knows what they are talking about. The father essentially said this. Also, if they object, somehow that will negatively affect the care received. This is a real fear; I've been there myself!
The resident did not present the father with all the options.
"If you're uncomfortable with Student Doctor Green performing the test, who has never done this on a live patient, I can do it or my supervising physician can."
Seems to me that information is required for true informed consent.
The reality is patients are not presented with this information because it hinders the hidden agendas of providers.
Ed
Ed, that's how it goes in teaching hospitals (hospitals with residents, interns and medical students), the attending physicians are not around at all times and the responsibility for teaching patient diagnosis, care and procedures to the medical students are left to the residents. "Been there and done that" as a medical resident myself. When the attending physician appears, they are responsible for making rounds with the residents, interns and students to the patients' beds and then reviewing the charts and "counter-signing" them along with any additional notations by the attending.
Yes, unfortunately there are "hidden agendas" of the patient providers in a teaching hospital. One of the most pervasive is the desire of each member of the team to be on the "good side" of the superior who in the final analysis is going to "grade" them. This leads to ignoring misdeeds, mistakes or unethical behavior observed conducted by the superior. This fear of loss of "grade points" or recommendations is one of the factors leading to persistence of the "hidden curriculum" where the superiors teach those below them clinical practice matters which may not meet the educational standards for ethics and humanistic behavior or standards of care which those "inferiors" had learned previously.
It's sad..but on the other hand there will be excellent superiors to guide the students and there will be students who despite knowing necessity to be on the "good side" of the superior, will speak up to the superior or report wrong behaviors. You will definitely want those students as your doctor. ..Maurice.
I truly appreciate your forthright honesty on these issues. The problem for the lay public is there is no objective means a patient can identify "those students as your doctor." Your profession expects blind trust and faith on the part of the patient and yet its truly a roll of the dice whether its rewarded with ethical care.
Ed
Particularly if they look young, I ask point blank "Are you the attending, a resident, or an intern?". If a resident "What year?". It's amazing the dance some do (or even the nurses) to try to avoid answering those questions.
TAM
TAM, for those patients who "care" about the experience of those who attend to them in a hospital, I think there is a most important question to ask, if you don't already know, and that should be directed to the hospital administration such as the clerks as part of the first contact. The question is "Is this hospital a TEACHING hospital?" Regardless of the answer, the next question should be "What healthcare providers are being taught here? Interns, residents, medical students, nurses, nursing students, technicians?" If the answer is "yes" to either of these questions, you should ask whether the patient can specifically request not to be attended by any of these individuals. Based on the answers provided by the hospital, you then have been "informed". Unless you are critically ill and unable to go elsewhere, despite your rejection of attention by these "learners", you may have to grin and bear it! Usually nothing terrible will happen. ..Maurice.
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