The Degraded Patient
I’m a little worried it’s my institution (and former members of the team I’m on) that this woman rightfully complains about in the NYT yesterday. (I only say this because the woman is from a nearby city, and our service does a lot of breast surgeries.) However, in none of my experiences has anyone done anything remotely similar to what the patient describes:
Mary Duffy was lying in bed half-asleep on the morning after her breast cancer surgery in February when a group of white-coated strangers filed into her hospital room.
Without a word, one of them – a man – leaned over Ms. Duffy, pulled back her blanket, and stripped her nightgown from her shoulders.
Weak from the surgery, Ms. Duffy, 55, still managed to exclaim, “Well, good morning,” a quiver of sarcasm in her voice.
But the doctor ignored her. He talked about carcinomas and circled her bed like a presenter at a lawnmower trade show, while his audience, a half-dozen medical students in their 20′s, stared at Ms. Duffy’s naked body with detached curiosity, she said.
After what seemed an eternity, the doctor abruptly turned to face her.
“Have you passed gas yet?” he asked.
“Those are his first words to me, in front of everyone,” said Ms. Duffy, who runs a food service business near San Jose, Calif.
“I tell him, ‘No, I don’t do that until the third date,’ ” she said. “And he looks at me like he’s offended, like I’m not holding up my end of the bargain.”
I’d be just as upset as this woman if I was treated that way in the hospital. On my service, we always knock before entering a room, we greet the patient, we tell the patient what we’re about to do (“I’d like to take a look at your incision”), and we always cover a patient of any area that doesn’t need to exposed. Any time we remove a part of a patient’s gown, we make sure to close the curtain in the room.
Also, our teams are two medical students max–not half a dozen.
Just curious…shouldn’t the docs ask the patient if they mind if medical students come in?
We do the same Graham. Sometimes the med student load is more than 2–but not usually.
L, we don’t usually ask if they mind medical students. Of course, the hospital where I am has “university” in the name, so I think it becomes understood that there is learning going on. Perhaps that is a poor judgement, but it’s just something we do.
But we always introduce (and state our “rank”–it’s now the law in S.C.), and are polite. But I haven’t been on surgery yet…
Jeremy’s right, L. Part of the assumption at a teaching hospital is that you’ll be seen by medical students, interns, residents, pharmacy students, etc. If they really wanted to, patients could say that they didn’t want to see a medical student, but most of them are supportive of the learning process.
That’s interesting…maybe it differs by state or institution? I’m in Texas, and anytime a med student was going to be involved they asked me if it would be okay if they observed – most of the time I said sure, come on in – except when it came to my cervix and I vetoed that one.
L, it might be different by doctor and especially in the clinic situation.
I’ve had doctors ask if I could see patients, but that hasn’t happened but once or twice during my rotations (it’s happened in the first two years of school–just not this one).
Most patients are surprisingly open to allowing medical students to participate. And I’m glad–how else would anyone ever learn? ;-)
Going back to the original article, the patient’s perspective on the encounter is just that — the patient’s perspective. I would imagine that if one tape recorded an encounter, then asked both the patient and physician to recall aspects of it, there would be differences between the doctor and the patient — and neither would match the tape. (With the rapidly declining cost of digital storage, I would anticipate that someday an audio recording of the all exams will become a standard part of the medical record … and that would improve medicine in so many ways, not the least of which being a clear record for legal cases.)
I tend to dismiss media articles recounting patient experiences because they are either going to quote patients with horrendous experiences, or those that have glowing reviews of their physician. That is what makes for a good story. Yet, neither case is the norm.
However, that doesn’t mean that we often forget that while we spend every day and every waking hour in the hospital doing the same thing over and over again (“How is the pain? Have you passed gas? Did you get out of bed yesterday?” etc), that we fail to remember that it is typically our patients’ first experience in the hospital, and they don’t know what to expect. And that adds another fear to the pile of unknowns that they brought to the hospital when they became ill.
Having worked at a few military and civilian hospitals, patient respect is not asked…it is required. It not only channel conversation between the physician and the patient but it also put the establishment into a whole, new perspective. I don’t think I would feel confident being treated at a hospital where my privacy is disregarded; my being and dignity is violated. Even if its a university where med students are obligated to learn by observing a real patient, they need to receive the patient’s permission first. That’s why the Privacy Act was initiated.
The issue of “asking” for permission to be seen by a medical student is a tricky one. but not a unique one.
First off, I should preface this with stating that I strongly believe that all medical students should present themselves as what they are…..students. None of this “student DOCTOR” stuff where the “student” is inaudible or the medical student who thinks he’ll trick the pt by wearing a long coat etc.
With that being said I think that if a student presents himself as a student he doesn’t need to formally ask “Is it OK if I come in with this group of doctors”
There are definately cases of assumed (or is it presumed) consent in a hospital and in a university hospital the prospect of haing medical students be around is one of them. Think of how many more invasive things “real doctors” do without getting consent/permission. How many times is blood drawn without telling the pt exactly what tests are being sent. How often is it presented to parents that “today little Jimmy is getting his 1 yr shots” instead of “would you be OK with us giving little Jimmy his vaccines today?”
Just my 3 cents
Humilition and the Hospital Experience–
Post Traumatic Stress Disorder is the name of my research project.
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During my training (and subsequently), we never treated patients as she described. I guess it could have happened though.