OB brings med student without permission

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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.

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I have nothing in the way of citations for you. But I wanted to say "Good for you." And offer support. I would have been furious had I been the mom. Actually, I would have told them all to get out. I had a student nurse (female) when I had my 2nd. I was asked if it was okay if she was in for the delivery. Was fine as she was with me all during labor (and she was a doula :) However, had she showed up at the last minute I would have said no. Had they just brought someone in (med student or nurse) I definately wouldn't have had my 3rd there. So maybe you could say it is bad customer service. I mean that is what it is all about to mgmt right. Return visitors.

Good luck.

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I have worked at two teaching institutions. The MDs ALWAYS ask if they may bring a student along. I can't believe this guy doesn't ASK. He must not see his patients as people.

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Specializes in Geriatric Psych, Physicians office, OB,.

A few years ago, my sister in law was in labor. I, as a nurse, was at her side to help with anything she needed. When it came time for her delivery, the doc would not allow me to go in for the delivery, but allowed her live-in husband to go in (who she was in the middle of kicking out of the house). Right after they wheeled her in the delivery room, the doc called for 2 student nurses who were observing in OB that day to come on in and watch the delivery. Furiously, I went up to the doc and said "no way! I'm a relative, and a licensed nurse... if I'm not allowed to go in, neither are they!!!" And my sis in law voiced her same opinion immediately, too! We were both so mad at the doc.

Mind you, this is a doc I know well - he delivered both my kids and was good friends with my dad; we'd known each other for years. But he claimed that according to hospital policy, the only person allowed in the delivery room was a spouse/partner or med students. I said, "Bah-humbug". So I just stood there at the delivery room door, and kept inching it open, bit by bit until I was basically in the room with them! (They never even noticed!)

At our hospital, and especially in this day and age, what with HIPPA and all you MUST have the patient's authoriziation for anything such as students observing or entering their room.

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A few years ago, my sister in law was in labor. I, as a nurse, was at her side to help with anything she needed. When it came time for her delivery, the doc would not allow me to go in for the delivery, but allowed her live-in husband to go in (who she was in the middle of kicking out of the house). Right after they wheeled her in the delivery room, the doc called for 2 student nurses who were observing in OB that day to come on in and watch the delivery. Furiously, I went up to the doc and said "no way! I'm a relative, and a licensed nurse... if I'm not allowed to go in, neither are they!!!" And my sis in law voiced her same opinion immediately, too! We were both so mad at the doc.

Mind you, this is a doc I know well - he delivered both my kids and was good friends with my dad; we'd known each other for years. But he claimed that according to hospital policy, the only person allowed in the delivery room was a spouse/partner or med students. I said, "Bah-humbug". So I just stood there at the delivery room door, and kept inching it open, bit by bit until I was basically in the room with them! (They never even noticed!)

At our hospital, and especially in this day and age, what with HIPPA and all you MUST have the patient's authoriziation for anything such as students observing or entering their room.[/quote/]

Were the students allowed to go in anyway??

Boy, would I have been PO'd if they were!

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Specializes in Maternal - Child Health.

I support you 100% in talking with this inconsiderate boor, and also in empowering his patients to refuse "spectators". Perhaps the next time he appears in a patient's room, you can say, "Hello Dr. So and So, would you please introduce your student to Mrs. Mother to Be?" That way the patient will know that this person is someone whose presence is not required!

My dermatologist is a clinical professor at one of the Chicago medical schools, and he frequently has students in the office with him. I have NEVER had a student walk in without the doctor expressly asking my permission, and I'm fully clothed! I can't imagine the indignity of having excess (and unnecessary) people present during an OB/GYN visit without my permission.

I agree that HIPAA may be the way to approach this. Especially with all the paranoia that exists about the legislation.

Good luck and thank you for advocating for your patients!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I support you 100% in talking with this inconsiderate boor, and also in empowering his patients to refuse "spectators". Perhaps the next time he appears in a patient's room, you can say, "Hello Dr. So and So, would you please introduce your student to Mrs. Mother to Be?" That way the patient will know that this person is someone whose presence is not required!

My dermatologist is a clinical professor at one of the Chicago medical schools, and he frequently has students in the office with him. I have NEVER had a student walk in without the doctor expressly asking my permission, and I'm fully clothed! I can't imagine the indignity of having excess (and unnecessary) people present during an OB/GYN visit without my permission.

I agree that HIPAA may be the way to approach this. Especially with all the paranoia that exists about the legislation.

Good luck and thank you for advocating for your patients!

excellent.

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Specializes in ER.

Although I agree that students should have the patients' permission I have never seen it done in any of the hospitals around here. In fact, just the opposite- on the consent they sign when they are admitted (and no one reads) they give permission for any and all students to watch, assist, or DO anything that a regular doc would do. Plus permission for any future research or studies that might come up for a chart study. There is no blatant unprofessionalism if someone declines a student, but there are mutterings at the desk, and a little less compassion. The attitude is, "they came to a teaching hospital, they have to expect to have students."

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HIPAA speficially allows students to participate as part of the team and have access to health information.

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Specializes in Maternal - Child Health.
HIPAA speficially allows students to participate as part of the team and have access to health information.

Does this not require the knowledge and consent of the patient?

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Specializes in NICU, PICU, educator.

Nope..if they are with the team HIPPA does not apply. We just had this discussion with our legal department.

I know at our hospital, they ask if med students can do u/s, etc. They just kind of tag along. They are also the ones doing the admission paperwork for OB then they give it to the resident who checks it and follows up. That is how it is in our teaching hospitals too...you are at a teaching institution and therefore you will not have the attending every minute of the day.

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No - it does not require the patient's authorization. It is one of many exceptions to HIPAA. You can go to the HIPAA Privacy Rule and do a search on students and trainees. http://www.hhs.gov/ocr/hipaa/privrulepd.pdf

Just because HIPAA allows something does not mean any agency cannot set stricter limits. The hospital could establish a policy that all studnet are to be introduced as students and obtain verbal consent for participation.

Here is an ethical debate about it.

http://www.medicalcrossfire.com/debate_archive/2000/dec_00/Ethics.htm

An article:

http://www.menshealth.com/cda/article/0,2823,s1-3-67-0-1537-2-3-2,00.html

UK Policy

http://www.qub.ac.uk/cm/undergrad/intimate-examination.pdf

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