OB brings med student without permission

camay1221_RN · Feb 9, 2005

I work at a teaching hospital with an OB clinic. Pts seen in the OB clinic are told at the very beginning, they will have students, residents, fellows, etc. involved with their care, and they are required to sign a disclosure stating they understand this. If they are not willing to allow all the above, then it is recommended to them to seek a private practitioner.

sjt9721, BSN, RN · Feb 9, 2005

The OP didn't say that her institution was a teaching facility. Right?

I'm wondering if the hospital knows that this physician is bringing in students. Typically students of any kind (EMS, Nursing, RT, PA, Med) have to be 'approved' through Administration to be in the facility. (I use the word 'approved' for lack of a better term!) Patient consent may be a moot point if the doc is bringing in people without upper-level authorization. His office is one thing...the hospital is another. If he can bring in any med student he wants, what's to keep him from bringing in his nephew who is a pre-med major? :uhoh21:

stsdoc · Feb 9, 2005

I definitely agree that medical students should be introduced as students, or introduce themselves as students. I think this is happening more and more, but then again, I was introduced as Dr. XXXX a few months ago while observing a procedure. It made me feel a little uncomfortable, because that makes people think I know more than I do. I don't think med students need permission to learn however, especially at teaching hospitals, where patients are made aware beforehand. It's not like we are just bums off the street. At my school, we all receive HIPAA training and are well supervised. Also, we are easily identified as students by our short white coats and ID badges. Any unprofessionalism/confidentiality violations would result in SEVERE consequences.

SmilingBluEyes · Feb 9, 2005

I still say the patient should have a say in who is involved in her care. Students can be excluded at her request, including medical students, if she say so.

stsdoc · Feb 9, 2005

I still say the patient should have a say in who is involved in her care. Students can be excluded at her request, including medical students, if she say so.

Patients do have a choice. They make it when they choose to go to a teaching hospital. Of course, if a patient asked me to leave, I gladly would oblige, but this is definitely not common practice.

SmilingBluEyes · Feb 9, 2005

is this a teaching hospital Betsy? And oh yes, you can refuse. I get my care at a teaching facility and have refused in the past. I had specific reasons why, when a student doc mishandled me grossly. We DO have the right to refuse, even in these places, unless consents are obtained to let them into the case. Believe me, you can refuse. Just not too many people know this.

URO-RN · Feb 9, 2005

is this a teaching hospital Betsy? And oh yes, you can refuse. I get my care at a teaching facility and have refused in the past. I had specific reasons why, when a student doc mishandled me grossly. We DO have the right to refuse, even in these places, unless consents are obtained to let them into the case. Believe me, you can refuse. Just not too many people know this.

Yes, you can refuse as Deb said. I did it when my kid was born. I made a request of no students MDs or nursing students. It was a difficult pregnancy, and I wanted to minimize traffic in and out of my room. I asked them to put my request in the chart and post a note outside the door. One student doc came in anyway, and told me he was going to examine me. :rolleyes: I let the poor chap talk. He obviously didn't check my chart or look at the sign on the door before coming in.

And like Deb said, not too many patients know that they can have a say on who comes into the room.

Jussurfin · Feb 10, 2005

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.

I, too, would be upset, if not furious, with any professional, medical or otherwise, who treated me this poorly or thought of me as an object instead of as a human being. I am more tolerant of rudeness and bad behavior in the general public but when I visit or am being treated by a 'professional' I expect and demand to be treated with the utmost respect. Unfortunately, medical practice acts, under the heading of 'unprofessional conduct,' do not include a clause that says all patients MUST BE treated with courtesy, dignity, respect, etc. Such acts should include such a clause. Perhaps the people who wrote the MPAs assume too much in thinking that anyone who is a "professional" would know this and do nothing less. This is a false assumption, of course.

It's good that your are an advocate as very few patients in the situation you described are able to confront a medical professional when they are being mistreated because of the 'psychology of the situation." By this I simply mean any patient in a state of undress is vulnerable. It is difficult for many, many people to be assertive and speak their mind when they are in a vulnerable, prone position when those around them, especially a group of people, are fully clothed and standing. They are in a "power position": standing and clothed. The patient is in the submissive position: prone and undressed. In such situations and if being shown no respect, many if not most people can be rendered speechless and, in some rare cases, be reduced to tears. This is the "psychology of the situation" and basic human nature at play. Unscrupulous doctors who want "their way" are well aware of this and they take advantage of it showing no respect, whatsoever, to the patient. Such doctors are also poor excuses for human beings. On the other hand, some doctors are just clueless and evidently have no upbringing.

As you suggested, I would discuss this matter with the doctor in question. If he doesn't change his ways, I would pursue it with the higher-ups in administration. If no one does anything about this doctor, he will continue in his unprofessional, disrespectful ways.

Forget HIPAA, the Constitution, which, by the way does NOT grant an individual the 'right to privacy," and the medical practice acts. There was a simple phrase written in a "book" long before any of the aforementioned were written and enacted on how human beings should treat one another that simply said, "Do unto others as you would have them do unto you." It is a sad commentary that some medical "professionals" have no respect for the Golden Rule either.

Mermaid4 · Feb 14, 2005

He should , of course, ask the patient for permission or consent, however, if she has signed something in the office, or the admission consent includes that she might be delivered or seen by others at the practice, she may have inadvertantly signed permission before she ever showed up on the unit. Sometimes the admission consent is the consent involved.

WhatToDo · Feb 14, 2005

I am completely disgusted after reading the article posted about by bergren(http://www.menshealth.com/cda/article/0,2823,s1-3-67-0-1537-2-3-2,00.html)! Reading this makes me not even want to go to nursing school.

I can't believe students are asked to examine patients lady partslly, rectally or the like while under anesthesia. This is absolutely gross and inhumane, it's like having sex with a corpse! Or even worse, being drugged and gang raped. If ever asked to do this in school, I would quit.

I see a point in that obtaining consent may reduce student's chances of learning, however, I doubt that a lot of patients would not give consent for students to be present if given the opportunity. Just because a patient is seen at a teaching hospital doesn't mean they have to let students be part of their care.

I doubt I will ever go to a teaching hospital for care and will probably tell my family not to either. This is just too disturbing.

Mermaid4 · Feb 15, 2005

The patient, whether or not she signed a consent which implies either outright or otherwise, DOES have the opportunity to regulate care, and can CERTAINLY refuse to have students despite the implied affirmative consent. Most patients don't realize this or don't mind. I don't mind if a student "tags along', but that might be because I am a nurse interested in having students learn correctly. Of course the hospital is aware that students are involved because they wouldn't otherwise be there. Any patient has the right to refuse care and noting by signiature that you understand students may be involved or participating in your care does not mean that you can't have a say in it. Many people are willing to have students, or just aren't aware that they can ask not to be seen by them. Every patient we see gets a copy of the patient bill of rights. Also, with Hippa, you can obtain your own results either by phone or by checking the computer BUT if the doc office specifically wants you to send for and then submit a medical release OR if the hospital claims that you cannot access your records on THEIR computer, you have to abide by that. As for the person who thinks people are routinely examined lady partslly under anesthesia, don't forget that in labor and delivery, epidurals are anesthesia but you are awake, and consenting to same if the doc and his or her med student are there. It is not a reason not to go to nursing school, and perhaps you might investigate things a little more thorougly before you do. Of course there are exceptions to these rules , but in the world of medicine, we know that happens a lot. Bottom line. Pt has the right to tell an attending that they would prefer not to have hands on care by a student. WHATever consent was signed. And this does NOT only apply to teaching hospitals. To the person who thinks they might avoid teaching hospitals if they get into nursing, you are going to miss out on so much that it might not even be worth going to school......Don't judge a book by its cover. Be concerned about patients. Thats what makes a good nurse great, but be informed. People are individuals, and not all of them are as knowledgable or as educated as we are. Thats why we advocate for them.

CHATSDALE · Feb 15, 2005

I have been in a teaching hospital with my son everyone introduced themselves as the md...the resident...interns..etc

they were even aware that his problem was short term memory loss...and they reindroduced them self on succeeding days..they were very professional..

but i agree that the papers that are thrust upon you are not really 'informed' consent/\..and if you are in need of a dx you don't quibble