Pelvic exam during general anesthesia ??

[PregnantAt51]

Did you read the admissions paperwork, or just sign it? Did you read the consent, or just sign it?

I read it. It said "as deemed necessary" which I could not have known meant "necessary for furthering education of medical students" rather than necessary for my best outcome.

---

Members don't see this ad.

 

[DermViser]

@PregnantAt51, No. You asked what it meant, so I told you. I wasn't asking you for it.

 

[PregnantAt51]

I very much appreciate everyone who took the time to talk with me. Even the skeptics were helpful. Thinking over how I can present this to the adolescents in a way that will be helpful to them.

I realize all of you are very busy, but if anyone wants to know more, you are welcome to inbox me. Thank you again.

I'm not a troll, crazy or a liar. I'm 51, and the child I had is 22.

 

[PregnantAt51]

Lol if my kid is being born and and a flock of medical students are essentially assaulting my wife and shes screaming in protest, they're all going to get launched and the hospital is going to have a serious legal case on it's hands. You realize if that actually had happened, this would be national news? If so, then I'm sorry for an unfortunate situation and hope the reparations were sufficient in your opinion. That must have been horrible and I can't imagine what that would be like. That's literally the worst patient to physician/student story I've ever heard.

If not, then stop trolling.

It's like this: if it was common treatment of women at the time and in the area, and no lawyer would take your case, it doesn't make the news. You pay the $9000 that isn't covered by insurance and try not to think about it.

Consent is everything. I probably would have allowed the students to learn all they wanted from my birth if they'd just treated me with respect. I guess they knew there would be no recourse for me, so they did what they wanted. Like I was a cadaver.

 

[PregnantAt51]

No. Even if I called the hospital to get the medical records, I WOULD BE UNABLE TO DO SO WITHOUT YOUR WRITTEN PERMISSION TO GO ON FILE. You should know hospitals don't give out HIPPA protected information as easy as you are saying they do.. Are you willing to give me your real name and phone number? I'll call you right now. Let's do this.

PM or inbox or whatever you call it on this site right now. I'll send you a number. I already said I'd give you consent if you email me a form.
Also, I don't claim to be a medical student, so how would I know about HIPPA requirements?

 

[PregnantAt51]

who explains an episiotomy like that? especially if you are too "shy" to let medical students touch you.. so detailed "STARING AT MY VULVULA?" LOL, this is a joke.

Wow, no need to be mean. You're intentionally misinterpreting. Using the word "vulva" to describe a vulva doesn't mean I want strangers rummaging around anywhere they please.

Someone else also said that knowing the word "platitude" indicated that I was not a real patient. It seems that somehow lack of consent and being mistreated by medical students couldn't happen to someone with a decent vocabulary?

Whew, nasty.

 

[fab4fan]

A lot more than that happened. For instance, no one said a word about the episiotomy until I saw a long needle for the saddle block. The students or residents or whatever they were gathered around staring into my crotch while the attending pierced my perineum. I screamed, arched my back and tried to scoot away, saying "No! No episiotomy! I'd rather tear! Don't!". One of the boys between my legs patted my thigh and said 'We're just making the opening a little bigger." I said "No, you can't do that without cutting me!". Somebody shoved their finger down into my the muscles just inside my vagina (sorry, don't know the name) to stretch the tissue. The pressure caused intense pain and I arched again and said "Ow, oh stop that hurts..." The student/residen/boy said "One minute..." then I felt a burning pain and heard flesh being cut with scissor. I wasn't numb yet. My husband said I screamed "what are you doing?", my eyes rolled back, blood fell onto the floor and I began sobbing. The boy looked up and said "See? All over." like he was putting a band-aid on a toddler. I tore another inch as my child's head was born.

Any protests I gave were either ignored or I was placated with platitudes like "You're almost done". They never addressed anything that I said or asked them to do or not do.

There was one moment when the three were between my legs touching and staring at my vulva, which felt so humiliating. I remember feeling that getting pregnant was a terrible mistake and I was paying for it. A woman should not feel guilty for giving birth!

One of them said "Look, I see hair!" as though this would cheer me up. I snapped "Well I guess you do. Haven't you ever seen one of those before? They have hair."

I was not a welfare patient, btw. I had full insurance and was paying for the services of a private physician. One of the residents/students even poked fun at my husband, saying " well, if you want the pros, don't have a baby at 6pm on a Friday. They've all gone home."

My point here is that it seems doctors have forgotten that pelvic exams, gynecological procedure, breast exams, giving birth, those processes can feel terrible, and in a lasting way. To you, it's routine. To some of your patients, it's like being stripped and penetrated against our will, in the middle of Wal-Mart. Our feelings are valid.

I am trying to find a way to give the youth group girls a balanced view.

I find it odd that someone who joined just today would comment only on threads related to pelvic exams, males being asked to leave during pelvic exams, etc. Why resurrect a thread nearly 10 years old about males being present during a pelvic exam? Don't you have anything else to contribute?

Many years ago there was a poster (not a physician/nurse) who was focused on feeling violated due to pelvics. These posts are reminiscent of her content.

 

[fab4fan]

The only time I recall refusing a med student was during a visit at my gyn/onc. I've had a lot of complications from my chemo regimen, and I was feeling so beaten down that day I just couldn't be concerned about someone else. My doc was more than OK with it.

When I recently had a rather complex surgery to deal with one of the issues from the chemo, I had med students, residents, and a fellow. I was totally fine with it. My attending did a really good job of explaining just what the students, residents, and fellow would be doing during the surgery.

When I am admitted to the hospital, I scrutinize the consents with a fine tooth comb. Anything I don't want gets a line drawn through it.

I understand that students need to learn; I was a nursing student, so I understand how uncomfortable it can be to have to get patients to allow you to participate in their care. I had patients say "No" to me as a student. They had that right.

 

[Elisabeth Kate]

This case does not happen. No doctor would ever let a student touch a patient without consent

Yes, it does happen. Going back to the subject at hand, students are sometimes asked to practice their pelvic exam skills on unconscious patients who have not been told the student would be doing that. This is a fact, not an opinion.

No. Even if I called the hospital to get the medical records, I WOULD BE UNABLE TO DO SO WITHOUT YOUR WRITTEN PERMISSION TO GO ON FILE. You should know hospitals don't give out HIPPA protected information as easy as you are saying they do.. Are you willing to give me your real name and phone number? I'll call you right now. Let's do this.

What's your MRN? Your name? We can't get your file just by the date. Is 10/4/91 your birth date?

Maybe the date of service?

Seriously, we've crossed the line into insane now.

The only time I recall refusing a med student was during a visit at my gyn/onc. I've had a lot of complications from my chemo regimen, and I was feeling so beaten down that day I just couldn't be concerned about someone else. My doc was more than OK with it.

When I recently had a rather complex surgery to deal with one of the issues from the chemo, I had med students, residents, and a fellow. I was totally fine with it. My attending did a really good job of explaining just what the students, residents, and fellow would be doing during the surgery.

When I am admitted to the hospital, I scrutinize the consents with a fine tooth comb. Anything I don't want gets a line drawn through it.

I understand that students need to learn; I was a nursing student, so I understand how uncomfortable it can be to have to get patients to allow you to participate in their care. I had patients say "No" to me as a student. They had that right.

Wonderful post. You summed it up beautifully -- most patients are fine with students helping with their care, but they want to be asked. Should a patient refuse a med student, it's their RIGHT. You aren't guaranteed the right to do whatever exam you want on any patient you want just by virtue of being a medical student.

 

[Armadillos]

Cant be bothered to sift through all the less than amazing posts from folks on both sides of this arguement.

First for the exam under anesthesia bit, this is really easy. If its not relevant to the procedure you don't do it, if it is relevant to the procedure it will be part of the consent. I know our hospitals GYN surgery consent forms always list "Exam under anesthesia" as the first procedure and then the actual surgery as the second, form also says that trainees will be participating in the procedures.

Second for the situation of having a trainee present for something like a pelvic exam. This situation is simplified greatly if the clinic is being run in a way were the student is actually acting as a member of the treatment team and not just observing. If the student goes in first and does the interview, goes out and presents and then comes back with the attending/resident, then the patient gets the benefit of often having a much more thorough interview with 2 opportunities to think of questions/concerns and then the student is actually part of the treatment team so its not strange for them to be doing the pelvic exam as well. If the patient asks not to have the trainee present, then we can step outside.

 

[Anastomoses]

the gender divide in this thread and lack of sensitivity to consent to a pelvic exam is fascinating.

 

[evilbooyaa]

Dude, seriously stop.

I would also point out that 25 years ago...there was a lot less regulation, a lot less supervision of students, and a lot more paternalism...

This. Flamen, let this go. Seriously, this is getting weird.

PregnantAt51, I'm sorry you went through that. Sounds like a hellish experience, and I cannot speak to how different things were back in '91. It is very possible that things have changed very significantly.

What I would ask you tell your adolescents is that stuff like that happening in 2014 would be so incredibly rare that if what happened to you happened again, the hospital would be cutting you a blank check, even if you have the most inept lawyer in the country.

Yes, it does happen. Going back to the subject at hand, students are sometimes asked to practice their pelvic exam skills on unconscious patients who have not been told the student would be doing that. This is a fact, not an opinion.

I've done exams on patients under anesthesia before, and in every single case, there was clear consent and we discussed it in pre-op. All this being said, in MS2 we discussed the possibility of this exact situation happening and how we would react to it as a MS3. Unfortunate that it still happens, ever.

 

[PregnantAt51]

Don't assume this thread represents the views of the majority of physicians. These are medical students, some of them not even in their clinical years yet. They're at the stage in their education (and life) where they're extremely entitled and feel like the world owes them every opportunity to learn their craft and anyone who impedes their learning is an adversary. This is not the predominant philosophy in medicine.

Thank you for this perspective. It is very helpful.

 

[boogaloo]

Yes, it does happen. Going back to the subject at hand, students are sometimes asked to practice their pelvic exam skills on unconscious patients who have not been told the student would be doing that. This is a fact, not an opinion.

I've done exams on patients under anesthesia before, and in every single case, there was clear consent and we discussed it in pre-op. All this being said, in MS2 we discussed the possibility of this exact situation happening and how we would react to it as a MS3. Unfortunate that it still happens, ever.

That's interesting. I did multiple pelvic exams every day for four weeks in clinic, so I guess I don't understand the lure of "practicing" in the OR unless it was indicated in the first place. Most of the time the residents would just do a quick one before proceeding with the case. The concept of giving consent for medical students to poke around my private areas to refine their skills is weird to me (e.g., "I don't really need a foley for this procedure, but I'll let you guys practice putting one in"), but I guess there is a possibility that the students aren't getting enough practice elsewhere.

 

[DermViser]

That's interesting. I did multiple pelvic exams every day for four weeks in clinic, so I guess I don't understand the lure of "practicing" in the OR unless it was indicated in the first place. Most of the time the residents would just do a quick one before proceeding with the case. The concept of giving consent for medical students to poke around my private areas to refine their skills is weird to me (e.g., "I don't really need a foley for this procedure, but I'll let you guys practice putting one in"), but I guess there is a possibility that the students aren't getting enough practice elsewhere.

My understanding is that the times these were done, were when it was indicated, not for the heck of it. The user who resurrected this thread, and another one on the same topic, is complaining about it being done under anesthesia, regardless of the reason.

 

[Elisabeth Kate]

I think everyone on this thread should read this article:

Practicing pelvic exams on women under anesthesia purely for teaching purposes — not for the women’s medical benefit — is not a new practice. However, many may have assumed it had largely stopped, particularly after a 2003 study (which I discussed several years ago) drew a lot of attention to the issue, causing many medical schools to clarify their policies and/or seek women’s explicit consent. Several professional medical organizations have also denounced the practice.

The study was based on a 1995 survey of students at five U.S. medical schools. The researchers found that only about a third of the students thought it was “very important” to get consent prior to doing a pelvic exam. Students who had actually done an ob/gyn clerkship were even less likely to think consent was important. Almost 10 percent of those students actually responded that explicit consent was “very unimportant.” The overwhelming majority (90 percent) of the ob/gyn clerkship students had performed pelvic exams on women under anesthesia

http://www.ourbodiesourselves.org/2...till-be-having-pelvic-exams-under-anesthesia/

And the link to the Journal of Obstetrics & Gynecology where the students' account appeared:
http://journals.lww.com/greenjourna...inations_Under_Anesthesia__A_Teachable.1.aspx

 

[deleted500612]

Are there examples of this actually happening?

How about a lesbian ENT playfully slapping her anesthetized patients' dicks around while having a good laugh with her OR team?

Oh yeah and she's still practicing!
http://www.scsun-news.com/ci_13887704

 

[Kahreek]

pre-meds and general populace, that's why we cant have nice threads discussing relevant points, somebody gets shocked at some point. ffs

If pelvic exam is relevant (eg ob/gyn surgery) i find no difference to letting a student do a knot under teaching. And messing a knot can be more dangerous.

 

[Kahreek]

DermViser, I'm not sure I understand what the lost relationships and other negative aspects of entering the medical field have to do with not wanting to be used as a teaching tool unless I have specifically consented to this activity.

you are gonna be used as a training tool in any hospital that has residents in much more critical procedures than pelvic exams.

 

[DrCharlemagne]

How about a lesbian ENT playfully slapping her anesthetized patients' dicks around while having a good laugh with her OR team?

Oh yeah and she's still practicing!
http://www.scsun-news.com/ci_13887704

Disgusting. How has her medical board not put her through the wringer?

 

[DermViser]

Disgusting. How has her medical board not put her through the wringer?

Bc she's a lesbian woman who can probably claim there was nothing sexual about it. So much for doing their job of protecting the public.

 

[DrCharlemagne]

Bc she's a lesbian woman who can probably claim there was nothing sexual about it. So much for doing their job of protecting the public.

As with the previously discussed pelvic exams, sexual pleasure or titillation are not the sole determinants of sexual abuse. If anything, since sexual crimes are often more about exerting power than sexual gratification, and since she is the physician here and entrusted with a fair degree of power over her vulnerable patients, this is clear cut sexual abuse and her license ought to be stripped and criminal charges brought forward. If only we lived in a perfect world...

 

[evilbooyaa]

How about a lesbian ENT playfully slapping her anesthetized patients' dicks around while having a good laugh with her OR team?

Oh yeah and she's still practicing!
http://www.scsun-news.com/ci_13887704

Wee. Now the third(?) thread we're discussing this woman.

 

[Keona]

This is to pregnantat51 but in the main thread, since I rarely log onto my name. I'm a 4th year student now. I had my daughter during medical school. I chose to not have her in our main teaching hospital since I didn't want to have a physician who might be one of my attendings do the delivery. I requested no male students when asked, and allowed 2 nursing students. They were gone before the birth, I guess they got to leave the hospital at normal hours. The only time something happened without my consent was when she became stuck at the end and everyone was pushing on my stomach, and doing their best to get her out of there quickly. Now I think it may have been a shoulder dystocia. This wasn't even without consent, just something that wasn't explained in full detail before it happened. (I would not have wanted time wasted on full detail of it either).

I have also done my obgyn rotation at our main hospital that serves more people without insurance and at a hospital with private providers. I felt our main hospital had better nurses, but I had less time at the outside hospital. I was privileged to get to be a part of many teenage girls care, not necessarily their delivery, but discussing dates with them, finding out about their pregnancy, etc.

For your young teens (this is what we did for everyone, not just teenagers)
In the triage area: I always introduce myself as the student, and ask if it's okay if I speak with them. We did not do any invasive exams without a resident being present. We would usually get the whole back story, and go and speak with the resident. The resident would come back in, explain who they were, and ask if it was okay if an exam was performed. While speaking with the patient I'd ask if it was okay if students were present, and if they minded male students being present. (about 50 % of the patients on my rotation did not want male students present for exams, but were fine with them for csxns, and ultrasounds. These wishes were completely respected, and were passed along to the students coming on after us. If someone requested no students that was fine as well. The only time I heard something negative, was when a student had been intimately involved with the patient's care, and asked to leave the room during the delivery. The male students probably saw 1/2 as many vaginal deliveries as me, simply b/c I was female, and the mother's were okay with me being present. Most of these men will not be going into OBGYN. One of the male residents explained to one of the expectant moms who said his exam was less uncomfortable than others was because his fingers were longer and thinner than most. None of the moms ever objected to the male resident that I can remember, he just always made sure he had a female present with him in the room.

My point of this long story is to say that we explain everything to patients, especially the teens. They tend to be more scared and freaked out about what's going on anyways. We had awesome nurses who were great at talking to the expectant and laboring moms as well. Consent is a big deal, and no student wants to be present when someone doesn't want them there. It was one of the most amazing experiences during medical school to get to hold a new life in my hands, and say congratulations as you transferred the baby to their mother's belly. (Kangaroo care in our hospital) The residents and attendings strongly warned us that we needed to go in and speak with the mothers about us being present, since we would not be allowed in the room if we had not before delivery was imminent.

 

[deleted500612]

Wee. Now the third(?) thread we're discussing this woman.

Thread is about conducting pelvic exams during anesthesia... someone asks for an example of a pelvic exam being done on a patient that was completely unrelated to their care... this seems about as relevant as you can get.

 

[FutureInternist]

Most patients at teaching hospitals interact with residents and med students (short white coats) all the time when they're there for their care.

Out of all the posts here, I am most impressed with the correct usage of "they're, there & their"....and all within one sentence....Kudos !!!

 

[neusu]

Read the OP, saw it's a Necro-Bump.. Didn't read the current discourse

In my experience:

Unexpected pelvic exams never happened.

That means, when I was on general surgery, there weren't pelvic exams unless it was a RO LLQ etc.

On Gyn surg etc. there may be a conga line of fellows, residents, medical students who put their fingers in the patient's vagina to feel the ab/normal pathology.

Simple fact of the matter is that trainees have to learn. The care of the patient may be compromised because of this. The comfort of the patient may be compromised because of this. The identity of the patient me compromised because of this.

We are all professionals, yet we inflict this harm on our patients by virtue of our training. It is our fiduciary duty to learn from these experiences, and to teach others to learn from similar experiences so as not to degrade the privilege.

 

[tco]

Wonder what everyone that refuses students is going to do when the students become physicians, and the current physicians all retire? Thank god your kids will be treated by machines.

 

[IrisSong]

Some of the commentary here worries me. It should always be the patient's choice and it should be explained to them before the procedure. I haven't had gyn surgery, but I've been under general anesthesia. The consent form was rushed, it wasn't explained to me and I wasn't able to fully read it (this wasn't an emergency either). I hadn't realized a resident was going to be directly involved in my care, but I would have liked to have known that he was going to be involved (this is excluding any possibility of a pelvic exam).

The only arguments I've heard in my brief skim of this thread is that a) there's nothing wrong with it and/or b) we need to practice.

You don't need to practice at the cost of ethics. There are other routes to do this which aren't unethical. You can make the argument that not practicing leads to inferior physicians.......but that pales in comparison to unethical ones.

Guess, I really will have to read the fine print from now on.

 

[colbgw02]

For everyone espousing the right of the patient to refuse care from a student or trainee (which I agree with, BTW), do you believe that the attending also has the right to discharge a patient from his/her care for such a refusal (assuming that the transfer of care is handled appropriately)?

 

[IrisSong]

I wouldn't deny them the right, I suppose, if it was up to me, although, I'm not sure how it would be justified medically. Seems a bit coercive (petty?) if patient refusal was the sole reason to discharge a patient.

Is it typical for MD's to choose to not treat/discharge a patient if they disagree with the patient's position in terms of treatment (i.e. MD wants to do it one way, Patient wants to do it another way....MD no longer feels comfortable treating)?

 

[Flamen04]

This thread is the reason why urology > obgyn. Handling penises are much more straight forward.

 

[Siggy]

This thread is the reason why urology > obgyn. Handling penises are much more straight forward.

I thought most penises (penii?) had a slight curve to them.

 

[colbgw02]

I wouldn't deny them the right, I suppose, if it was up to me, although, I'm not sure how it would be justified medically. Seems a bit coercive (petty?) if patient refusal was the sole reason to discharge a patient.

Is it typical for MD's to choose to not treat/discharge a patient if they disagree with the patient's position in terms of treatment (i.e. MD wants to do it one way, Patient wants to do it another way....MD no longer feels comfortable treating)?

Medical justification is irrelevant. I'm not proposing abandonment.

You question whether or not it's petty, but let's turn that around - I could ask if it's petty of a patient to refuse care from a trainee, particularly when that patient either knows or should know that they're seeking care from a teaching institution.

 

[IrisSong]

I don't consider it petty to refuse care from a trainee colbgwO2.

 

[colbgw02]

I don't consider it petty to refuse care from a trainee colbgwO2.

Just so we're clear, this is how you see it:
-patient presents to teaching hospital/clinic, learns that trainees will be involved with her care, categorically refuses said trainee-provided care - not petty
-attending at teaching hospital learns of patient's categorical refusal, politely but firmly discharges patient from his/her care - petty

 

[IrisSong]

It's been presented here that if a patient prefers not to be treated by trainees then they should "simply" go to a different hospital. We all know it's not as simple or convenient as that. A patient always has the right to consent, to not be resuscitated, and/or to leave AMA.

A physician is typically encouraged to treat patients regardless of their beliefs, positions, opinions, etc, even if they conflict with the physician's view points.

 

[colbgw02]

Well, you're applying two different standards. With respect to the patient, you use the word "right". Patients do have those rights, to be sure, but contrast that against the standard you use for the physician - no mention of rights - just what is "encouraged". Aren't patients at teaching hospitals "encouraged" to particpate in the training process? A physician has a right to refuse a patient care (again, we're not talking about abandonment), particularly if the patient refuses to accept care in the manner chosen by the physician, which - in this case - is with the aid of trainees. I just don't see why the exercise of the physician's right is petty, while the assertion of the patient's right is not.

 

[Winged Scapula]

Unfortunately, some of my colleagues are incorrect about consent for treatment and the role of a trainee in that consent.

Medical professionals overestimate understanding of the trainee process by the layperson. A study in Academic Medicine, around 2004, showed that only 60% knew the difference between an intern, resident, fellow or attending and what their roles and responsibilities were. In another study, about the same percentage failed to realize that they could be the first person a resident or student does a procedure on. The obvious conclusion of these, and other studies, was that patients do NOT realize the difference between a teaching hospital and a non-teaching one, or that even when at a teaching hospital, that students and resident physicians may be providing some of their care. Interestingly, while they agreed that the students and residents had to learn in some fashion, a significant proportion of the subjects just didn't want it to be on them. NIMBY.

Secondly, patient autonomy includes the right to refuse care and who provides it. Simply being admitted to a teaching hospital does not require that a patient be treated by a medical student or resident physician. The attending of record may require that as a stipulation of his/her care and the patient then can decide whether or not to seek care elsewhere (as I have had attendings do in residency - in essence tell the patient that they could go elsewhere for their care because the students and residents would be involved; we had another who accepted the patient's refusal of resident care and we laughed our asses of when that Vascular Surgery attending not only had to round on the patient herself, but had to take those middle of the night phone calls from the nurses…LOL. Still amuses me to this day.) Health care providers should educate patients on the value of having students and residents involved in their care but must make sure that patients are willing to accept their participation. But bottom line: attendings absolutely have the right to refuse treatment to patients who refuse to accept care from trainees.

I cannot speak about 1991 but these days, when you are admitted to a hospital today, you will be provided with a mission statement which details the aims and educational activities of the institution. Patients have the right to refuse treatment and we are bound to respect that however, patients do not have the right to dictate HOW that treatment is provided or delivered.

The request for exclusion of medical trainees from a patient’s care is not unreasonable. However, for a facility that relies on medical trainees for day-to-day patient care, fulfilling such a request might require the facility to alter not just the care of this one patient, but its overall system of care. In particular, it may not be feasible for the facility to replace all of the functions normally performed by medical students, interns, and residents with attending physicians, nurses, and other health care professionals. The facility might not be able to fulfill this patient's request without unduly burdening the system or compromising the care of other patients. Thus, facilities are within their rights to refuse that request of the patient.

 

[IrisSong]

The physicians choice not-to-treat is not petty; the rationale is. Patients who refuse may be viewed as petty, but like the administrator noted upon it's the right of both parties.

Refusal is the only means of control a patient has within the system.

 

[Winged Scapula]

The physicians choice not-to-treat is not petty; the rationale is. Patients who refuse may be viewed as petty, but like the administrator noted upon it's the right of both parties.

While it is a right that both parties hold, I'd challenge the idea that refusing to treat patients who will not see trainees as petty. An academic physician working in a teaching hospital has chosen to make his/her career based on the education of future healthcare providers and makes sacrifices to realize that.

While I joked above that I was glad when one of my attendings acquiesed to a certain difficult patient that they not see students and residents, the truth was that I was disappointed that she didn't stand up to him and defend our right to education and her professional goals.

 

[IrisSong]

It's a difference in ideology.

 

[Winged Scapula]

It's a difference in ideology.

Yes and humans are allowed to have that.

But I would question why we allow patients to insist on their own ideology ("no trainees working on me") but insist on physicians violating their own? (I am assuming we are talking about non-emergency care).

FWIW, when I was in training, the worst offenders were actually physician's wives and on rare occasion, another physician.

 

[IrisSong]

Cops get a bad rap because they're expected by society to perform certain duties; They are criticized more harshly when they do something wrong because they are held to a higher standard. Lawyers are expected to uphold the law. Are doctors not held to different standards by society?

I'm of the mind that it's worse for a doctor not treat someone because a difference in viewpoint with the patient than it is for a patient to refuse care from a trainee.

No one would feel it fair for a physician to be degraded and made a slave.

 

[colbgw02]

Cops get a bad rap because they're expected by society to perform certain duties; They are criticized more harshly when they do something wrong because they are held to a higher standard. Lawyers are expected to uphold the law. Are doctors not held to different standards by society?

I'm of the mind that it's worse for a doctor not treat someone because a difference in viewpoint with the patient than it is for a patient to refuse care from a trainee.

No one would feel it fair for a physician to be degraded and made a slave.

I understand what you're saying, but your comparison to police and lawyers is inapt. The appropriate analogy for physicians would be causing harm to patients.

 

[Winged Scapula]

Cops get a bad rap because they're expected by society to perform certain duties; They are criticized more harshly when they do something wrong because they are held to a higher standard. Lawyers are expected to uphold the law. Are doctors not held to different standards by society?

I'm of the mind that it's worse for a doctor not treat someone because a difference in viewpoint with the patient than it is for a patient to refuse care from a trainee.

No one would feel it fair for a physician to be degraded and made a slave.

Of course physicians are held to a standard but there are no laws which require healthcare providers to offer care in elective situations.

The cop and attorney analogy is irrelevant here. I disagree that police officers and attorneys are held to a higher standard; they are held to the same standard as the rest of us. They get a bad rap because we expect they, more than Joe Citizen, will adhere to that standard and its disappointing, if not surprising, when they don't.

 

[IrisSong]

....ok......how about just this:

does society place different expectations on doctors than non-doctors?

 

[Winged Scapula]

....ok......how about just this:

does society place different expectations on doctors than non-doctors?

Absolutely.

For privacy reasons, I will not spend a lot of time detailing things/venting but let's just start with:

1) expectation to provide free or heavily discounted care;
2) expectation to provide service without being paid immediately

Americans in particular expect the highest quality health care, in the fastest possible fashion and don't want to pay for it.

No one would expect that they go to a restaurant and play Blimpie ("I'll gladly pay you Tuesday for a hamburger today") or ask their mechanic to provide a brake job for free.

 

[wholeheartedly]

I don't want to get into the fray of most of this thread, but I did want to reiterate that the whole "just don't go to a teaching hospital then" is a bit unrealistic for a lot of reasons.

For example, I'm an allied health professional and I work at a teaching hospital. I have employer provided health insurance and am only in network at said teaching institution. To hit on the medicaid discussion, I work more than full-time and pay my premiums and am far from freeloading off of the system.

It's also the only place in a very large radius to provide a number of services and care for more complicated medical conditions, so by virtue of the fact that people just happen to have those conditions they don't really have much of a choice in where they have to go for care.

Yes, it's my choice to work in a teaching hospital and I respect and understand that and am willing to participate as a patient, but the rest of the citizens really don't have much of a choice in the matter.

A significant number of people don't understand medical training and can't tell the difference between the phlebotomist in scrubs and the attending in scrubs.

The biggest issue here isn't so much the students practicing as it is how the learning experience is approached. Most of the patients around here are happy to let people learn on them They just appreciate the heads up and details first. No reasonable person is going to argue that students shouldn't learn on real patients at some point. They may not always be thrilled about it being them, but know it needs to happen.

I had to learn to do invasive stuff on patients and it was humbling. We always asked for permission. It's a sign of respect to the patient, it makes people who are sick and miserable and vulnerable feel like they have a little more control over what's going on and be active participants in their care. I was declined a couple of times, but also very humbled by some of the people who didn't decline. I remember doing phlebotomy on a oncology patient who was poked so often she probably felt like pin cushion. She definitely wasn't thrilled being approached by novice. Then I missed the first time and asked if I should get someone else to try again. She was obviously miserable and in pain. She said, "No that's ok, you need to learn. You can try again." Most people were like that if given the choice. I'm happy to give learner's the opportunity, because I've been one and because I intend to be in those shoes again soon. I really appreciate being asked though.

The other issue that's glossed over is that pelvic exams aren't always benign procedures. If you have certain medical conditions, the poking and prodding can be painful so not wanting extra people poking around exacerbating things is more than just psychological or a case of the patient sexualizing a very non-sexual procedure. Sometimes it just makes you more miserable.

The funny thing is, this institution is very good about asking permission for trainees to be involved and trying to make patients comfortable with things and being open about who's doing what and when. It seems to work very well here. It seems to create an environment of trust and encourages patients to be very open to letting learners participate. Overall, the medical students here seem seem really happy about the level of involvement and access they have here. It really doesn't seem like asking permission or being honest about the details is hurting anyone's education. So I don't see the problem going that route, as it works for both patients and trainees.

(Just an aside, as for some providers doing really questionable, stupid things? Yeah, head on over to the " I got fired from my residency" page and that's who you're looking at and yes some of these really inexplicable things probably did happen. I know I've seen some doozies in the years I've worked in hospitals. Fortunately it's a small minority of people doing that kinda crap.)

 

[wholeheartedly]

Americans in particular expect the highest quality health care, in the fastest possible fashion and don't want to pay for it.

.

Reminds me of the engineering triad. Fast, cheap, high quality, pick two cuz you can't have all three. ....


This short term gain, long-term sacrifice mindset is the biggest problem facing our country from politics to healthcare.