Doc beings medical student without permission - page 3
I have to ask you guys a question. Maybe this is more appropriate for another forum and if so, please point me in the correct direction. We have a fairly new male OB who has been in academia for... Read More
May 4, '10Quote from Fun2,RNBoth of my girls were born in a teaching hospital. Everyone and their brothers saw me..lol
At the point of being in labor.....WHO CARES!!!!?????!!!!
I would think that this isn't a big deal to the pts. They are dr's, or at least will be. It's probably bothering you more than the patient. Obviously those Docs (male and female) have seen the female anatomy before, whether it be live, cadaver, or pictures.
They need to learn the same as you did when in ....hands on training, and visuals of the real things that go on in the medical field.
I would hate some nurse to tell me I couldn't watch & learn something because "I'm a student".
Also, that Dr. may tell his patients that he occasionally brings students in.
With respect, and at the risk of sounding pompous ... it is never the patient's responsibility to meet the student's needs.
May 4, '10I really do understand what everyone is saying and as a patient advocate I agree it would be very appropriate to get the women's permission before you start examining her lady bits not to mention bringing other people to do so. But playing devils advocate, until you have an oppertunity to see and experience the examination process it is really difficult to learn. As much as I personally do not like the idea of additional people looking at me while I am so indisposed on the flip side having a doctor exmaining me that does not know what he/she is looking at is even more disconcerning. And as we all know most med students do eventually go up and become doctors. Advocating for our patients is important but also setting the tone of a professional teaching atmosphere where everyone is respectful and appropriate can also help put a patient at ease. I think a lot of it rests in how you present it.Last edit by SweetLemon on May 4, '10
May 4, '10my prior plastic surgeon (tumor removal not nose job) would bring like 5 or 6 students in every time i had a visit wth him. He would also just examine me in the hallway if he ran into me i just kinda got used to it, though I do understand examining my face is diferent then looking down there
May 4, '10Some hospitals are teaching hospitals, and when patients are admitted one of the things they sign is an acknowledgement this a teaching hospital. Imagine being a Nursing student and having to get explicit permission every time a student accompanies their teacher or preceptor when entering a room? Thanks to this type of set-up, as a nursing student I was allowed into rooms, to watch dr consults, into procedure rooms, and even into the OR. If people in the OR at my local hospital knew how many groups of students watched, including surgery on breasts or other 'private' areas, I don't know what they'd think.
In teaching hospitals,the patient can still refuse to have a student observe. I would assume that's still true in your hospital?
Is your issue that this is a maternity ward? Maybe I have a different perspective, but I don't feel being in the room during delivery is any less appropriate than a student doing a catheterization, being taught to do a prostate exam, or being in the OR for a cesarean. Unless the student is doing something inappropriate, making the pt uncomfortable, or breaking HIPPA... but I didn't get that idea when reading your post. If I went into labor and watching my situation helped future docs and nurses save others' lives, they're welcome to watch me suffer.
May 4, '10CeilingCat
No..I dont undestand...exactly why is it hard to get permission or to at least ask the pateint if they are comfortable with someone watching. I totally understand to learn the skills you need nothing replaces actually observing and getting that experience directly with patients but the patient ultimately should have say in who is sticking a finger in their you know what and if their is an audience watching.....
I read one guy state the reason they never asked is because he knew most would say no....(i think this was referring to OB situation i believe he was a student) but the idea that the patient comes to a teaching hospital has no say in wether she/he is on display for 2 or 10 students staring is just absurd.
I was a young teen in stirrups......long story short I was surrounded by no less than 6 other people,who never asked if they could come in...the humiliation of being seen by that many people is to this day the most degrading thing that has ever happened to me..It shoyuld have never been allowed to happen that way......This has been YEARS ago and I think about how horrible it was everyday...Im sure they are thinking gee if we ask this kid if we can watch her with her legs in the air she will say no so why dont we just go in and theres a good chance that the humiliation,young age and the emotional vulnerable state she is in will stop her from making a huge fuss about it.....
Its basic RESPECT.....
May 4, '10I know that here, students are not allowed in the room unless the patient gives permission. When I was on home health and midwifery clinicals, my preceptor would even have to call the patient at home first to make sure it was okay to bring a student.
I think it is only manners to ask, people are often feeling very scared and vulnerable as it is and having several pairs of eyes staring at you is probably more than a little disconcerting. I wouldn't mind having a student in the room with me, although anymore than two would be a party.
I remember having a patient though on a pediatric medical ward. She was a 14 year old anorexic and she was just the most heartbreaking sight. She was very subdued and quiet and for some reason she just seemed to take to me, so I became her main nurse. One morning, she asked me if it was okay to talk, so we did... and I spent the next hour documenting our very lengthy discussion. She asked me if she was going to die. She then saw her dietician, ward doctor and her psychiatric nurse in very close succession, which was obviously very important.
But literally as the psych. nurse is leaving her room, I see a group of 4 or 5 medical students, all jostling to get in her room. I asked if I could help them and one piped up, "Oh, well we heard you had an anorexic down here and we've never seen one before, we thought we'd all go and ask her some questions." (Just the way he said it annoyed me, if I'm honest).
I very politely told them that I didn't think that was such a good idea after the long day she had already had and ushered them away. I'm sure they thought I was being awkward, but I really felt I was just looking out for my patient.
I agree wholeheartedly that students (nursing AND medical) need to learn and observe, I was a student myself last year, but there's a time and a place for everything.
May 4, '10to ANGIE1011
Thank GOD for medical profesionals like you!!!!!
I only wish I had someone....ANYONE looking out for me when I was the patient that ALoNE would have saved me
from all these years of psychological/emotional trauma....
May 4, '10I know this is a Lazarus thread, but the concept is still important, so here I go....
Quite frankly, until now in my LTC and adult hospital rotations, I never thought about doing anything more than saying, "Hi, my name is _____. I'll be your student nurse today." Yes, the nurse assigned to the patient has come back to me once during those rotations to say, "The patient doesn't want a student nurse. You'll have to get another patient."
I shrugged my shoulders and got another patient. No biggie.
In anticipation of OB and peds which are coming up this summer, something in my gut said I needed to approach these upcoming rotations a bit differently. I anticipate a few more rejections of a student nurse than what I've experienced thus far. FWIW, the previous rejection came from a patient who was healthy except for the one procedure she was hospitalized for (an ortho floor). Anyway, I'm still not sure what to say except to continue what I've been doing....clearly identify myself as a student when I meet them for the first time. Does there really need to be more than that?
I've been lucky to have family members of patients that were really, really encouraging. I intro myself as a student nurse, and that's the end of my mentioning that; however, when my assigned patients have had family present, every single one of them has sent me off with sincere good wishes for my success.
As for myself as a patient, I've given birth twice with med students or PAs watching my crotch without my expressed consent. The first time, I had no idea that my OB was a "teaching" doctor. When I was wheeled into the delivery room, happy as a clam (pardon the pun) w/ an epidural and NO PAIN (thank the gods), I looked up at the wide-eyed students and said, "Doc, are you inviting more people in to stare?" I said it with good humor though, and my OB/GYN who has been my OB since I was 20, snipped back, "Do you want me to send more invitations?" I laughed.
For my second baby, my OB/GYN was teaching PAs. With an epidural that was working on only half my body, I had three (a lot less than with the first kid) PAs watching. My doc even let one of the PAs deliver the placenta. I distinctly remember one hand in my vagina and the other hand over my abdomen, and the whole experience feeling...well...ineffective. She was being way too gentle--barely any pressure on my abdomen at all--and it just felt like she would be there forever trying to get that thing out. I remember looking at her and saying, "I think you may need to check on your technique, ok?"
My personal approach to students? If I don't let them learn from me, who will they learn from?
Before anyone gets bent out of whack that I will impose MY opinion on my patients, I know that not everyone is like me, but I think more people are than we give them credit for. I will ALWAYS provide the utmost respect to my patients for their privacy.
But, the question remains, if a student is one-on-one with the intros, what more than saying "I'll be your student nurse/doctor/PA/NP today" is necessary or even overkill?
May 5, '10Quote from dudette10~Exactly my thoughtMy personal approach to students? If I don't let them learn from me, who will they learn from?
May 5, '10As an instructor, I believe it is important to model respect for the patient and their privacy. To that end, I would never invite a large number of students into a room! It is a hospital, not a circus. Patients have a right to know who is present and participating in their care, and a right to refuse the care of anyone. On rare occasions, I have had conversations with students about behavior, such as when they become so excited about a chance to learn that they cease to see the patient as a person with feelings and privacy issues instead of a learning case alone.
That said, part of it is in how you ask, especially in areas that might be more sensitive, for example, a male student in OB. I have actually heard someone say to a patient "You don't really want a male nursing student in here, do you?" in the same tone that you might ask "You don't really want a deranged mass-murderer in the room, do you?" This is not helpful, and who would say yes when it is phrased like that? My male students are pre-professional students just as my female students are. They are serving in a pre-professional learning capacity. I want them to have a good experience, but never at the expense of the patient. Asking politely, we have only had two patients refuse a male student, and 1 was for cultural reasons (this patient also wanted a female OB).
It was a good opportunity for me to discuss care issues and patient rights with all students.