Then I guess I had a fairly atypical shadowing experience as a high school student. I asked to shadow at a few places and was turned down at all but one. At that institution, I was only allowed to shadow because I had volunteered there for a few hundred hours, and because the physician was a close friend of my family and thus he could personally vouch for me.
It was easier to find shadowing opportunities in college, fortunately.
I think there should be restrictions on college shadowing too. Patients should know who is listening in/watching.
But getting back to your point: we need to weigh the concerns for the patient's autonomy (that I still disagree with) against the benefits for the student and nonmaleficence vis-a-vis the attending and the institution. The fact remains that if you're a high schooler interested in a BA/MD, you're not getting in without shadowing. Period. Until that changes, shadowing will be a sad necessity for assiduous high school students interested in medicine.
Patient autonomy when the patient has capacity is always the first priority, non-maleficence is not an excuse to impinge on autonomy except in very specific circumstances (and I disagree, this is not maleficence, see below). More importantly, physicians are healers first and educators second. Once you are in medical school you will rapidly appreciate this, as there are many situations when the care of the patient will
and should take precedence. We are here to serve first and teach second. However, that is not the key point. The point is that lying to patients about who an individual is is never appropriate on the grounds of education, be it letting a pre-med listen into a sensitive conversation on the grounds that he is a "student doctor', or convincing a patient to let a medical student perform an gynecological exam because he is a "
student doctor". I have no problem with people shadowing, I believe in the educational experience entirely, my point is that there are certain things about shadowing that I strongly disagree with. I don't intend to say that these are necessarily the student's fault, but they are not appropriate.
1) Calling a pre-med a student doctor, because it is misinterpreting the situation and biasing a patient towards your will, not their own. Even as a medical student I still get kicked out of rooms. You can't tell me that not a single additional patient would dispute a pre-med (and I have seen this done to pre-meds when I was allowed in the room as a medical student). This is maleficence, on the grounds that they are being deceived to serve your purposes not theirs, which is not healthy for the relationship, and they are also unknowing placing themselves at a higher risk of having their confidentiality compromised. You have no idea how many admissions essays I read on SDN that have the patient's REAL NAME and information in it. I don't deny that medical students and physicians do it to, but the accountability is far less and the understanding of what is compromising is also much less.
2) Pre-meds wearing white coats while shadowing because it, again, misconstrues their role and thus the potential level of trust a patient may have.
3) Pre-meds in the operating room prior to draping and covering. There is NO reason why a pre-med should watch a patient being undressed, having a foley placed, etc. This is not a learning experience and it is an unnecessary exposure of the patient's privacy to outside eyes..
4) Pre-meds in the OR at all without patient consent. Again, unnecessary exposure of the patient's privacy and concerns about the correlation of number of people coming and going in the OR and risk of post-op infection.
5) Pre-meds witnessing genital, breast, and rectal exams. Again no real learning experience (these are really things you have to "feel" to really benefit from) and major exposure of the patient's privacy and dignity.
6)Pre-meds doing the genital, breast, and rectal exams. Nuff said
7) Pre-med shadows participating in any patient care or procedures without patient consent. I don't even have that much of a problem with it, unlike some, but the patient should know who is suturing their arm or whatever. There are other ways to teach "cool" skills like suturing than using unaware patients as an advertisement for our profession. Get a banana peel or a piece of raw chicken.
Regarding the attending and the hospital, well, imagine if they had to introduce students as "high school student interested in medicine." That would put down the student, first of all, but that doesn't matter. It would also reflect badly on the Attending, who is apparently letting high school students tag along. And finally, it would reflect badly on the hospital, which also lets high school kids follow physicians around. Why should we harm everyone just for the sake of a few words?
How does this put down the student? It is TRUE, if you are offended by such a comment then that your choice, but their is no disrespect intended. We were all high school students once and many of us were interested in medicine. An interest in medicine at any level shouldn't win you some special award.... How does it make the attending look back by encouraging early interest in the field? How does this make the hospital look bad? By allowing interest in medicine in a patient protective way? I'm sorry, but these suggestions just don't reflect the reality of my experiences in medicine. Do you know what really looks bad, when news breaks that a hospital and their physicians have been lying to patients. Looking bad is not a justification for lying.
And anyways, I still disagree that we're impinging on the patient's autonomy, we're just taking a looser definition of a word "student doctor" (whose legal definition most patients won't even know). The term "student doctor" can have a legal definition as well as a colloquial definition. The legal definition is undoubtedly crucial as far as patient care is concerned. But with regards to the high school student, patient care doesn't matter, because he's certainly not involved in it. Basically, I don't see how the legal definition of the phrase is applicable in a situation that doesn't involve patient care for the "student doctor."
I'm sure the CEOs before the crash also felt they were just loosening definitions. The absence of a patient's knowledge of the legal definition does not give us the right to exploit their lack of knowledge. You know who else exploited a lack of patient knowledge? The people at Tuskegee. Not the same degree of inappropriateness, but on the same spectrum. Privacy and informed consent are PART of patient care, thus it matters. This doesn't even get into the fact that it places the institution and physician liable if privacy is exposed and the patient was told that a pre-med was a medical student.
Finally, if the term "student doctor" is problematic just because it already has a legal definition and is thus ambiguous, why not refer to them as "doctor in training," "doctor-to-be," "future physician," "studying to become a doctor," or whatever. As far as the patient is concerned, what does it matter? If the patient ever feels uncomfortable, they can say "get out" at any time (and they do!) and the student has to leave.
High school students aren't necessarily doctors to be and future physicians, for one. And again, studying to become a doctor is ambiguous enough to misconstrue the relationship. It matters because it is their decision to make and it matters because their privacy is at risk.
90+% of college premeds don't make it to med school either. I'd wager that kids who shadow physicians in high school are more likely to get into medicine, just because very few of them do it, and self-selection is huge there.
All of what I said applies to pre-meds regardless of age.