Better to not send physician LOR?

[zogoto]

---

Members do not see this ad.

So far I have 6 LORs (2 science profs, 1 non-sci, 2 PIs, one club advisor from a leadership exp) plus a committee letter which quotes all of these and is attached to the packet of 6 letters.

I have another letter also, from a doc I shadowed for about 80 hours. I've decided that this is probably the weakest letter since I mostly just shadowed, but I also met w/ patients on my own while he was overbooked and took a history, vitals, etc. and then told the doc when he came in. In addition, I did a small (10 hours) project he was thinking about for his dept.

Is this letter worth to add into my packet of letters? Pretty much everyone shadows, but I thought this was a little unique. The problem is that adding it would make for a thicker packet which might annoy some adcoms that have to read them all...

 

[shemarty]

I would actually include it. I know it's a lot of letters, but I sent a packet of 8 letters. My situation seems similar to yours: 2 science, 1 non science, 2 PIs, a faculty advisor from a leadership experience, an attending at the free clinic where I volunteered, and a physician shadowing letter because it was a pretty unique shadowing experience.

He can talk about how well you interact with patients, how you asked really insightful questions, how eager you were to learn, how you would make an excellent clinician, etc.

The part about you taking a history, vitals, etc, without his supervision is sketchy, so maybe he shouldn't mention that detail.

 

[flip26]

I would actually include it. I know it's a lot of letters, but I sent a packet of 8 letters. My situation seems similar to yours: 2 science, 1 non science, 2 PIs, a faculty advisor from a leadership experience, an attending at the free clinic where I volunteered, and a physician shadowing letter because it was a pretty unique shadowing experience.

He can talk about how well you interact with patients, how you asked really insightful questions, how eager you were to learn, how you would make an excellent clinician, etc.

The part about you taking a history, vitals, etc, without his supervision is sketchy, so maybe he shouldn't mention that detail.

More importantly, the applicant should not include this in his app, either. How embarrassing for the doctor, especially if the doc provides an LOR...it is also the pinnacle of arrogance for an untrained pre-med to take patient histories, based on what? The methodology he has seen on "House, MD?"

 

[235009]

if your pre-med committee allows you to have 7 letters then by all means send it in! adcoms won't be "annoyed" at all because most of them don't read the actual letters and only read the committee summary...so it doesn't matter if you have 2 letters attached or 20 letters....all that matters is whether your committee will allow it.

As for the experience you got while shaddowing...i think it's excellent, just don't overplay it too much...rather than saying you took "patient histories" you can say you did a "preliminary patient history" or something of the sort. i had premed friends who were allowed to do many things they weren't supposed to do like drawing blood in the ER without any phlobotomy training! I don't think adcoms will be sitting there analyzing the implications of what you write from an ethical and HIPAA standpoint....as long as the doctor in charge allowed you to do these things (especially if he subsequently mentions it in a LOR) and the patient didn't object then you're in the clear.

 

[zogoto]

More importantly, the applicant should not include this in his app, either. How embarrassing for the doctor, especially if the doc provides an LOR...it is also the pinnacle of arrogance for an untrained pre-med to take patient histories, based on what? The methodology he has seen on "House, MD?"

What is the big deal about this? He told me which 5-10 questions to ask each time (e.g. “What medications are you taking, what are the main concerns you want to talk about w/ the doctor today, have you had any major falls or illnesses since the last time you came in, what kind of exercise do you get and how often, what is our daily diet like, etc”). I would write it all down and tell him later in front of the patient. Also, anyone with 5 minutes of training can take a blood pressure, pulse, and weight, and he would often check the BP, which is the hardest to take (or sometimes he would use the machine to check, but that is pretty inaccurate).

The letter is already written though. Should I refrain from including it then? We spoke about the letter both before and after he wrote it and I’m sure he included this kind of “extra” stuff that I did (that took it beyond just shadowing). He also said he mentioned that a few patients have commented on my interactions with them, and also that he thinks I will make a great clinician. There is also an anecdote about an infamous patient of his that I managed pretty well despite the pt’s angry personality. But wouldn’t any letter from a doctor say all that stuff?

skinMD, my committee letter allows as many letters as want. But some schools I called said that everyone that reviews your app has to read everything, so to only have great letters or else they'll have to wade through a lot of garbage. That made it sound like there is a potential for annoyance.

 

[flip26]

What is the big deal about this? He told me which 5-10 questions to ask each time (e.g. “What medications are you taking, what are the main concerns you want to talk about w/ the doctor today, have you had any major falls or illnesses since the last time you came in, what kind of exercise do you get and how often, what is our daily diet like, etc”). I would write it all down and tell him later in front of the patient. Also, anyone with 5 minutes of training can take a blood pressure, pulse, and weight, and he would often check the BP, which is the hardest to take (or sometimes he would use the machine to check, but that is pretty inaccurate).

The letter is already written though. Should I refrain from including it then? We spoke about the letter both before and after he wrote it and I’m sure he included this kind of “extra” stuff that I did (that took it beyond just shadowing). He also said he mentioned that a few patients have commented on my interactions with them, and also that he thinks I will make a great clinician. There is also an anecdote about an infamous patient of his that I managed pretty well despite the pt’s angry personality. But wouldn’t any letter from a doctor say all that stuff?

skinMD, my committee letter allows as many letters as want. But some schools I called said that everyone that reviews your app has to read everything, so to only have great letters or else they'll have to wade through a lot of garbage. That made it sound like there is a potential for annoyance.

So clearly you have played this up in your app, in the activities section, or in your PS.

I think it is highly inadvisable, but I am just another pre-med, so feel free to ignore my advice...but you might want to run it past LizzyM or someone like that...

 

[zogoto]

This is not played up in my apps except for saying that I "took basic pt histories, vitals, and got to speak to pts 1 on 1" in the activities.

The main issue is in considering the letter.

 

[flip26]

This is not played up in my apps except for saying that I "took basic pt histories, vitals, and got to speak to pts 1 on 1" in the activities.

The main issue is in considering the letter.

If you don't see the ethical implications in this - someone with no training doing the work of a licensed health care professional - you are not looking very hard.

This has the potential to rub adcoms the wrong way.

Ask LizzyM...and post it here.

BTW: You have 3 opinions on the thread - 2 telling you to not overplay it, and then mine telling you to leave it out altogether.

 

[zogoto]

Agreed. I asked LizzyM and also emailed the doc himself to ask his opinion/preference.

 

[235009]

bottom line is: if this letter portrays a side of you that doesn't come out in other letters then include it. forget about these silly concerns about what you did that would only come up by jealous/uninformed SDNers

 

[zogoto]

bottom line is: if this letter portrays a side of you that doesn't come out in other letters then include it. forget about these silly concerns about what you did that would only come up by jealous/uninformed SDNers

It does portray a side of me that doesn't come out in other letters (the clinical side) but I'm wondering if that's meaningful because any physician that writes a letter for someone who shadowed him/her will say something similar, about good bedside manner and good questions and reading up on interesting cases to ask about later, won't they? I didn't really "excell" as a shadower, except in doing some medical assistant-type stuff and that short volunteer project with him.

 

[flip26]

bottom line is: if this letter portrays a side of you that doesn't come out in other letters then include it. forget about these silly concerns about what you did that would only come up by jealous/uninformed SDNers

So now it is a silly concern, from a jealous/uninformed SDNer? Are all ethical questions "silly" to you?

You might want to go back and edit your post a few above this one.

 

[flip26]

Agreed. I asked LizzyM and also emailed the doc himself to ask his opinion/preference.

Great. Let us know what they say.

 

[235009]

So now it is a silly concern, from a jealous/uninformed SDNer? Are all ethical questions "silly" to you?

You might want to go back and edit your post a few above this one.

this isn't an "ethical question" ....all you need to do in order to be qualified to interview patients is be HIPAA trained which consists of a half hour video (or manual) full of intuitive patient confidentiality tidbits and a multiple choice "quiz" that you can take until you get all the questions correct. this is often done online.

very often students (undergrad, grad students, etc) with no medical training interview patients for epidemiologic studies.....does this also constitute an "ethical question"? ....absolutely not. Again, as i said, as long as the doctor thinks you are qualified (most preferably you would have gone through this HIPAA training first and many hospitals require you to do so before you shadow) and the patient is aware that you are a student and does not object then you can knock yourself out.

so as i said this is a non-issue drummed up by SDNers (who might have taken one ethics class and now think they're experts or who want to give their future selves more importance).

i do reitterate my previous point though that you shouldn't play this up too much. i think mentioning it in the activities section and using toned down language is perfectly fine.

 

[flip26]

this isn't an "ethical question" ....all you need to do in order to be qualified to interview patients is be HIPAA trained which consists of a half hour video (or manual) full of intuitive patient confidentiality tidbits and a multiple choice "quiz" that you can take until you get all the questions correct. this is often done online.

very often students (undergrad, grad students, etc) with no medical training interview patients for epidemiologic studies.....does this also constitute an "ethical question"? ....absolutely not. Again, as i said, as long as the doctor thinks you are qualified (most preferably you would have gone through this HIPAA training first and many hospitals require you to do so before you shadow) and the patient is aware that you are a student and does not object then you can knock yourself out.

so as i said this is a non-issue drummed up by SDNers (who might have taken one ethics class and now think they're experts or who want to give their future selves more importance).

i do reitterate my previous point though that you shouldn't play this up too much. i think mentioning it in the activities section and using toned down language is perfectly fine.

No evidence the poster took any such class or had any formal training or certification.

This was not interviewing for an epidemiology study - this was actual patients, there to see a doctor.

So since you are so sure that there is no ethical issue here at all, why the advice to tone it down? If it is not an ethical consideration, then why not list it in all detail?

 

[235009]

No evidence the poster took any such class or had any formal training or certification.

This was not interviewing for an epidemiology study - this was actual patients, there to see a doctor.

So since you are so sure that there is no ethical issue here at all, why the advice to tone it down? If it is not an ethical consideration, then why not list it in all detail?

i used to recruit for epidemiologic studies in an ER...those were "actual patients" (as opposed to fake patients?) there to see a doctor.

as for the "formal training" ...as you can see from my description it's not that big of a deal.... i think any intelligent pre-med college student already knows all that stuff. from a legal standpoint it is probably in the doctor/hospital's best interest that OP be HIPAA certified.

the advice to tone it down is because pre-meds tend to exaggerate to try to impress people... it's important to realize your minimal role... but by all means say u took a preliminary/guided patient history and vitals.... but don't make it seem like your five questions cured the patient or that the patient would have died if you hadn't taken vitals (i'm exaggerating of course but u get the point)

 

[flip26]

i used to recruit for epidemiologic studies in an ER...those were "actual patients" (as opposed to fake patients?) there to see a doctor.

as for the "formal training" ...as you can see from my description it's not that big of a deal.... i think any intelligent pre-med college student already knows all that stuff. from a legal standpoint it is probably in the doctor/hospital's best interest that OP be HIPAA certified.

the advice to tone it down is because pre-meds tend to exaggerate to try to impress people... it's important to realize your minimal role... but by all means say u took a preliminary/guided patient history and vitals.... but don't make it seem like your five questions cured the patient or that the patient would have died if you hadn't taken vitals (i'm exaggerating of course but u get the point)

Did the physicians rely on the history that was taken by the research students? I doubt it seriously...

Look, the poster has asked LizzyM and the doctor, too, so he is doing the prudent thing...let's see what he reports back to us. All I know is that I would not list these things on AMCAS - that's just me, maybe. I also avoided making any kind of judgments in my PS that could be construed as questioning the work I observed of doctors and other health care professionals...again, probably just me.

 

[NickNaylor]

To repeat what skin said, as long as the patients know that the person doing whatever to them is a student and not a doctor, I don't see any problem. While I don't advocate that HIPAA training should be optional, I think we can all agree that it is more of a technicality rather than an informative course. Unless you're entirely clueless about medicine, HIPAA just emphasizes common sense regulations.

Drawing blood, making incisions, and other similar tasks is one thing; doing a history on a patient, something a doctor can very easily verify or correct, is quite another.

 

[flip26]

To repeat what skin said, as long as the patients know that the person doing whatever to them is a student and not a doctor, I don't see any problem. While I don't advocate that HIPAA training should be optional, I think we can all agree that it is more of a technicality rather than an informative course. Unless you're entirely clueless about medicine, HIPAA just emphasizes common sense regulations.

Drawing blood, making incisions, and other similar tasks is one thing; doing a history on a patient, something a doctor can very easily verify or correct, is quite another.

I had to go through HIPAA certification courses just to be able to volunteer in clinical settings - did you not? For someone who is "shadowing," there may not have been any such training. In addition, before being allowed into clinical settings, I had to have a TB test. Perhaps this poster had done all of the above, but who knows?

There are rules and regulations, and this sounds pretty sketchy to me having an untrained and uncertified "student' in one on one situations with patients - perhaps if the doctor had stood in the room and observed the student, it would be one thing, but that is not what the OP did, nor is it what he is putting into his app...I think it is pretty shaky, but maybe I am alone in that opinion.

 

[zogoto]

I shadowed, volunteered, and was a researcher all in the same hospital, so yes I went through HIPAA, TB tests, badge, etc.

 

[flip26]

I shadowed, volunteered, and was a researcher all in the same hospital, so yes I went through HIPAA, TB tests, badge, etc.

But were you trained in taking patient physicals, and were you (and the facility where you did this) covered by their liability insurance? Not really your concern, but still...

There are liability considerations here - med students are covered by liability insurance, but I can't believe that untrained college students who are shadowing a physician are covered - the problem really isn't yours, it is the problem of the physician who allowed you to do this, and the liability exposure he created for the clinic or hospital where you did this...if you do use the letter, I think you would be doing the doc a favor not to play up this aspect of your experience.

I wouldn't play it up in my app (I wouldn't even mention it), because I think some adcoms are just as likely to question it as they are to think it was a good thing...

 

[LizzyM]

I'm not sure what's shady about being a medial assistant. What the OP were doing was very, very low risk with respect to potential harm to the patients and not much different from what a friend of mine, a HS graduate, did when she worked for an OB/GYN as a clinical office assistant. People do this type of stuff all the time in free clinics, etc. You aren't making diagnoses or making any decisions about what is relevant or not relevant to report to the doctor. The fact that you speak to the doctor in front of the patient makes it possible for the patient to correct you if you misreport something. Sometimes I'm just exasperated by the crap that gets passed along as gospel on the forum.

 

[flip26]

I'm not sure what's shady about being a medial assistant. What the OP were doing was very, very low risk with respect to potential harm to the patients and not much different from what a friend of mine, a HS graduate, did when she worked for an OB/GYN as a clinical office assistant. People do this type of stuff all the time in free clinics, etc. You aren't making diagnoses or making any decisions about what is relevant or not relevant to report to the doctor. The fact that you speak to the doctor in front of the patient makes it possible for the patient to correct you if you misreport something. Sometimes I'm just exasperated by the crap that gets passed along as gospel on the forum.

Fair enough; you are in a much better position to pass this judgment, and my recommendation was that the OP ask you.

OP, based on this, you should feel pretty free to mention it and even "play it up."

I work in a free clinic, doing patient interviews, but even there, I went through a 4 hour training class, in addition to the HIPAA, TB test, etc. I still find what the OP says he did to be a little out of the ordinary, but whatever...

 

[235009]

I'm not sure what's shady about being a medial assistant. What the OP were doing was very, very low risk with respect to potential harm to the patients and not much different from what a friend of mine, a HS graduate, did when she worked for an OB/GYN as a clinical office assistant. People do this type of stuff all the time in free clinics, etc. You aren't making diagnoses or making any decisions about what is relevant or not relevant to report to the doctor. The fact that you speak to the doctor in front of the patient makes it possible for the patient to correct you if you misreport something. Sometimes I'm just exasperated by the crap that gets passed along as gospel on the forum.

thank you!

you may now admit that you are wrong, flip26

Fair enough; you are in a much better position to pass this judgment, and my recommendation was that the OP ask you.

OP, based on this, you should feel pretty free to mention it and even "play it up."

I work in a free clinic, doing patient interviews, but even there, I went through a 4 hour training class, in addition to the HIPAA, TB test, etc. I still find what the OP says he did to be a little out of the ordinary, but whatever...

it doesn't (and didn't) take an adcom member to tell you that what the OP did was no big deal

again, don't "play it up" ...exaggerating your role will make you look silly

sounds like you are just bitter that you had to sit through a 4 hour training class and OP didn't lol

 

[nick_carraway]

I'm glad that LizzyM stepped in. People are informally trained as medical assistants all the time. A nurse trained me on how to ask those same medication questions, ask why a patient came to visit, etc. as part of the basic rooming procedure at a private practice. In fact, I reckon that most MAs aren't even certified in private practices.

The doctors just glance at what you wrote for the visit's purpose, ask the patient if it's true and go from there.

 

[zogoto]

So far I have 6 LORs (2 science profs, 1 non-sci, 2 PIs, one club advisor from a leadership exp) plus a committee letter which quotes all of these and is attached to the packet of 6 letters.

I have another letter also, from a doc I shadowed for about 80 hours. I've decided that this is probably the weakest letter since I mostly just shadowed, but I also met w/ patients on my own while he was overbooked and took a history, vitals, etc. and then told the doc when he came in. In addition, I did a small (10 hours) project he was thinking about for his dept.

Is this letter worth to add into my packet of letters? Pretty much everyone shadows, but I thought this was a little unique. The problem is that adding it would make for a thicker packet which might annoy some adcoms that have to read them all...

This brings me back to my original question (before I even thought of the potential problem with legal/ethical issues) of whether or not this letter will likely add something to offset the fact that it would be the 7th letter in the packet (not including the committee letter itself).

 

[nick_carraway]

This brings me back to my original question (before I even thought of the potential problem with legal/ethical issues) of whether or not this letter will likely add something to offset the fact that it would be the 7th letter in the packet (not including the committee letter itself).

I think it sounds valuable. Shadowing, IMHO, is useless. You've done more than that and you should emphasize it. Assuming you already wrote about it elsewhere in your app, you'll want to substantiate it with a LOR.

6 letters vs. 7 letters is not a huge issue. Just throw it in 🙂

 

[LizzyM]

I agree. Include the letter.

 

[flip26]

This brings me back to my original question (before I even thought of the potential problem with legal/ethical issues) of whether or not this letter will likely add something to offset the fact that it would be the 7th letter in the packet (not including the committee letter itself).

Definitely include it as part of the packet from the committee. Seven individual letters sounds like overkill, and from your own research you indicate that some med schools say as much.

One final thought: be prepared to demonstrate your skills - taking a history, obtaining BP and pulse, etc. Anything you include as experience is fair game in interviews. For instance, I am fluent in a foreign language, and I would be completely comfortable to conduct the entire interview in that language. If not, I would not have listed it.

 

[235009]

One final thought: be prepared to demonstrate your skills - taking a history, obtaining BP and pulse, etc. Anything you include as experience is fair game in interviews. For instance, I am fluent in a foreign language, and I would be completely comfortable to conduct the entire interview in that language. If not, I would not have listed it.

wrong. please stop. you are hurting my brain.

no interviewer is petty enough to "test" you on any skill during an interview nor are you expected to have any to be a viable candidate. If the language you are fluent in happens to be that in which your interviewer is fluent then your conversation might naturally veer toward that topic at which point he/she might speak to you in that language. but noone is out to get you or reveal you as a liar and if you go into an interview with that mindset it will be disastrous.

 

[flip26]

wrong. please stop. you are hurting my brain.

no interviewer is petty enough to "test" you on any skill during an interview nor are you expected to have any to be a viable candidate. If the language you are fluent in happens to be that in which your interviewer is fluent then your conversation might naturally veer toward that topic at which point he/she might speak to you in that language. but noone is out to get you or reveal you as a liar and if you go into an interview with that mindset it will be disastrous.

The stories may be semi-apocryphal, but people who have claimed skills ranging from language to piano playing to knot tying have been asked to demonstrate said skills...I would not claim an experience or skill that I could not speak about or even demonstrate with ease...in fact, it could be your moment to shine.

Why do you suggest that I think they are "out to get you?" If you similarly claim extensive research experience, you can similarly expect to be asked about it, and possibly to defend your research, to an interviewer who may know a thing or two about the topic...

 

[zogoto]

Definitely include it as part of the packet from the committee. Seven individual letters sounds like overkill, and from your own research you indicate that some med schools say as much.

One final thought: be prepared to demonstrate your skills - taking a history, obtaining BP and pulse, etc. Anything you include as experience is fair game in interviews. For instance, I am fluent in a foreign language, and I would be completely comfortable to conduct the entire interview in that language. If not, I would not have listed it.

This sounds contradictory to me. Definitely include the 7th letter, but 7 letters sounds like overkill?

 

[flip26]

This sounds contradictory to me. Definitely include the 7th letter, but 7 letters sounds like overkill?

If the letter is part of a premed committee packet, I would send it. It is almost as if it is out of your hands - it is what the premed committee wanted.

But if you don't have a committee letter packet and are designating each letter as an individual letter, that may be overkill...the physician LOR is the most superfluous of these letters.

 

[NoMoreAMCAS]

I'd include it. A physician you shadowed and spent several hours speaking with can much better assess your medical school potential than a professor who's class you took.

I don't even know why they want professor LOR's. They can look at your transcript and see how well you learn.

 

[zogoto]

My school is quite different from what you might be used to. We send all the letters we want to be included in our "committee" letter to the pre-professional advising office, then they send it to our advisor who serves as the "committee" and writes a summary of the letters, taking quotes from the letters in your packet, maybe from your personal statement, etc. I think he also gives some sort of overall assessment.

So we can choose what letters contribute to the committee letter. It's not like the committee/advisor wants some specific things...

 

[flip26]

My school is quite different from what you might be used to. We send all the letters we want to be included in our "committee" letter to the pre-professional advising office, then they send it to our advisor who serves as the "committee" and writes a summary of the letters, taking quotes from the letters in your packet, maybe from your personal statement, etc. I think he also gives some sort of overall assessment.

So we can choose what letters contribute to the committee letter. It's not like the committee/advisor wants some specific things...

In that case, I would include it.

When do they promise to complete the letter? I have heard nightmare stories about letters like that - the composite committee letter, which seems like an awful lot of work - not being finished until August or September...if you are otherwise ready to submit now, I would be tempted, in that case, to forego the committee letter altogether and have my writers send their letters to Interfolio, and then forward them to AMCAS.

 

[zogoto]

That would be a terrible idea for me to do.

The standard is August 15th that all letter packets are sent to schools/AMCAS. My advisor is out of town starting July 2 so he has agreed to do it by then. If he can't, it would still hurt me to forgo the letter since not only does everybody use the letter, he is an emeritus professor at my top choice, still has some pull in the admissions committee (after serving 25 years), and said he's going to write that I am in the top 1% of applicants from my school (Ivy).

When is it considered "early" to be complete by? August 15 not good enough?

 

[LizzyM]

That would be a terrible idea for me to do.

The standard is August 15th that all letter packets are sent to schools/AMCAS. My advisor is out of town starting July 2 so he has agreed to do it by then. If he can't, it would still hurt me to forgo the letter since not only does everybody use the letter, he is an emeritus professor at my top choice, still has some pull in the admissions committee (after serving 25 years), and said he's going to write that I am in the top 1% of applicants from my school (Ivy).

When is it considered "early" to be complete by? August 15 not good enough?

Aug 15 is fine. An Ivy student without a committee letter is a huge red flag. Those letters are very useful to us and if you don't submit it we wonder why.

 

[235009]

In that case, I would include it.

When do they promise to complete the letter? I have heard nightmare stories about letters like that - the composite committee letter, which seems like an awful lot of work - not being finished until August or September...if you are otherwise ready to submit now, I would be tempted, in that case, to forego the committee letter altogether and have my writers send their letters to Interfolio, and then forward them to AMCAS.

wow, do the SDN community a favor and stop giving "advice" ....you are clearly either clueless or you are trying to sabotage strangers on the internet. not getting a committee letter would be like stamping "I AM HIDING SOMETHING HUGE" on the front of your application

 

[flip26]

wow, do the SDN community a favor and stop giving "advice" ....you are clearly either clueless or you are trying to sabotage strangers on the internet. not getting a committee letter would be like stamping "I AM HIDING SOMETHING HUGE" on the front of your application

Dude, you can stop stalking me now.

 

[flip26]

That would be a terrible idea for me to do.

The standard is August 15th that all letter packets are sent to schools/AMCAS. My advisor is out of town starting July 2 so he has agreed to do it by then. If he can't, it would still hurt me to forgo the letter since not only does everybody use the letter, he is an emeritus professor at my top choice, still has some pull in the admissions committee (after serving 25 years), and said he's going to write that I am in the top 1% of applicants from my school (Ivy).

When is it considered "early" to be complete by? August 15 not good enough?

Again, with another piece of the puzzle now in place, I agree that you want that letter.

 

[Destro96]

The part about you taking a history, vitals, etc, without his supervision is sketchy, so maybe he shouldn't mention that detail.

I don't think that this is sketchy at all.

Physicians usually go over the history in detail, pretty much re-asking everything, using the information you were able to elicit as a guide.

With regard to vitals, I've seen this done by nursing students working alone in doctors' offices as part of an internship.

The bottom line is that most people doing both duties in physicians offices are not nurses, but "medical assistants." As someone already pointed out, a good number of these medical assistants have merely a high school diploma or GED and are trained in house.

This can be verified very easily. Note bullet #2 on the following page from the US Department of Labor.

Some medical assistants are trained on the job, but many complete 1-year or 2-year programs.