doc brings medical student without permission

ufmedic · May 17, 2005

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 years at another facility; therefor he is very used to teaching. His teaching is not the problem.
Recently, he has been bringing medical students (male and female) around on the unit when he is visiting his patients (who may be in labor). What is bothering me is that he will walk right in to the laboring woman's room with his student in tow and even examine a patient (lady partslly) WITHOUT asking her permission in advance. This is really beginning to bother me.
I know that he also does this in his on-site office because I have had this same discussion with one of his office staff.
I feel that his patient's rights are being violated when he does this. He has no business bringing anyone in with him, unless he asks their permission beforehand.
I intend to speak with him about this because as a patient advocate, I firmly believe that he is violating patient confidentiality, not to mention their right to privacy. But before I do this, I want to have my ducks in a row, so to speak so that I go up the chain of command properly.
Can anyone give me any citations or anything I can use as ammunition if I need it? I can go to our risk manager as well. I jsut want to do this right. I do not want to be confrontational but I want to protect his patients.
Thanks, in advance.

Most hospitals have a clause in the paperwork that the patient signs before admission stating that students and other observers may be present for teaching purposes and may actually be participating in patient care. It is not a confidentiality violation because learning to practice medicine makes it necessary to have access to patients and their records. All students are required to sign a confidentiality agreement.

CharlieRN · May 21, 2005

Most hospitals have a clause in the paperwork that the patient signs before admission stating that students and other observers may be present for teaching purposes and may actually be participating in patient care. It is not a confidentiality violation because learning to practice medicine makes it necessary to have access to patients and their records. All students are required to sign a confidentiality agreement.

Like he/she said. Check with your supervisor before you make a fool of yourself. If there is no such clause then indeed the doctor is in the wrong but I would be very suprised if that is the case.

Most likely the best way to serve your patients is to inform them that they may be observed by medical students, etc. Be sure you do that in a neutral or positive way because otherwise you will be undermining the mission of your facility and if they notice they will disipline you.

fergus51 · May 21, 2005

Every hospital I've worked in has had such a clause and every OB I know had patients sign the same thing when they agreed to it during their prenatal care. Are you sure his patients don't already know to expect this from him? They chose to accept his care prenatally and then deliver with him at a teaching hospital, so it's entirely possible they know this was part of the deal.

Tony35NYC · May 21, 2005

While I was in nursing school I did several rotations at a teaching hospital where medical students were also in rotation, and the hospital had the same deal with all of us. As long as we're being supervised by our instructors and we're functioning within the legal scope of our practice we didn't need any special permissions to examine a patient. Every patient who is admitted to this particular hospital is told beforehand that, as a teaching facility, the hospital permits medical and nursing students to participate in patient care, and this language is in the admission paperwork that the patient consents to with his/her signature. Of course, patients have the right to opt out and a few do but most don't care. As students, we all had to do a HIPAA review and sign a confidentialty agreement with the hospital and this is pretty much the way things are in just about every teaching hospital.

You say you intend to speak with the physician about this as a patient advocate, but I wouldn't be so hasty to do this if I were you, nor would I presume to know anything about the situation unless I had researched the facts first. You don't know what this physician discusses with his patients behind closed doors during prenatal care, so how do you know he doesn't tell them he will bring students when he makes his rounds in the hospital? You may end up being reprimanded by your superiors for being unprofessional and a troublemaker if you make accusations against the physician without knowing all the facts. No offense, but what really matters here is how the patient feels. Unless the patient is being abused, or there are legitimate safety issues, or the patient expresses concern about her privacy, etc. I would just let it be.

PMHNP10 · May 22, 2005

What is bothering me is that he will walk right in to the laboring woman's room with his student in tow and even examine a patient (lady partslly) WITHOUT asking her permission in advance. This is really beginning to bother me.

I don't believe it's a violation of confidentiality to do what he's doing, but it's clearly inconsiderate to come in and start poking and prodding without so much as an introduction. I'd think it would be a sure-fire way of getting slapped if nothing else.

Edit: I can't resist--Maybe you should ask the doc--Do you at least offer to buy the patient dinner when you're through?

MandyInMS · May 22, 2005

I don't know the rules/reg on this subject..all I know is I'd personally be upset as a pt to have an 'audience' without asking MY permission first..a simple introduction stating who this other person was, and why they were there, and would it be ok for them to observe would be a common courtesy.

TexasGas · Jul 28, 2005

I can't see where the Doc is wrong here. If he truly is just coming in and not saying hello, or at least acknowleding that there is a student there, that is bad manners and bad bedside manner. But if he wishes to retain his patients, I would assume that he tries to cover those bases. may he tells them at the office. Maybe some of these patients have actually seen the students at the office and know what is going on. We all have to learn somehow. If you are curious as to how he handles this situation, ask him privately first. Also, look and see if the patient is uncomfortable, but I wouldn't start by saying, "Does that bother you when he brings a student in here?" That is far too leading. A simple, "Are you comfortable?" or "how are you feeling?" would suffice.