HIPAA constraints prohibit shadowing?

[HenryH]

So I checked my cell phone for new messages earlier this afternoon and saw that I had one from the office manager of a physician with whom I left a message last week about shadowing opportunities. Apparently, because of "new HIPAA regulations," I'm unable to shadow this doctor because I "have no right to hear patient information." All text quoted is excerpted from her (the office manager's) message.

Is this doctor just trying to maneuver his way around declining my inquiry, or has HIPAA honestly established new rules that forbid shadowing experiences from taking place in accordance with patient privacy concerns?

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[RySerr21]

So I checked my cell phone for new messages earlier this afternoon and saw that I had one from the office manager of a physician with whom I left a message last week about shadowing opportunities. Apparently, because of "new HIPAA regulations," I'm unable to shadow this doctor because I "have no right to hear patient information." All text quoted is excerpted from her (the office manager's) message.

Is this doctor just trying to maneuver his way around declining my inquiry, or has HIPAA honestly established new rules that forbid shadowing experiences from taking place in accordance with patient privacy concerns?

HIPPAA has become more and more strict, and you will find doctors who are unable to let students shadow them for that reason. It happens, but you should still be able to find someone to shadow. Just ask someone else.

 

[saylorsdad]

i have had same problem in shadowing in local er. funnything is if i want to drive to okc i an shadow er without any problems. just keep looking you will find a doc that will let you follow him around.

 

[rajaholick]

both of the docs whom i shadowed asked every patient if it was ok for me to be in the room during the appointment
doesn't that effectively get around the whole privacy issue?

 

[andexterouss]

When I was looking for a doctor to shadow, I called several doctors and one of them actually wanted me to take a polygraph and some exam/test from the NYS Department of Health. Needless to say, I didn't bother.

The family doctor I finally shadowed, always introduced me as a student and I was asked to bring a short white coat and look professional. I think that puts the patients at ease. However, any sensitive medical issue was not discussed with me (patient with abortion, suicide history etc). Most of the patients came in for a physical or to discuss their common medical problems(hives, migraines, cholesterol etc). Also I was never given their medical records or asked to look at it. All I did was observe the doctor work. HIPAA are guidelines for doctors who don't know any better or tend to get carried away. Most doctors should know when to draw the line with premeds.

 

[Chocolate Bear]

I've seen a lot during shadowing that would probably violate a ton of regulations. It's all a matter of personal preference of the doc to determine how much liability he/she's willing to risk. There might be a millionth of a % chance that shadowing will cause a problem, but some docs just aren't willing to take said risk. And others just use it as an excuse. Like others have said, just keep trying. Most of us have been rejected in similar ways.

 

[andexterouss]

Also try to find a doctor has students(nursing, medical or PA) rotating with him/her on regular basis. These doctors are very pleasant to be around with and love having you around .

 

[Semicolon]

both of the docs whom i shadowed asked every patient if it was ok for me to be in the room during the appointment
doesn't that effectively get around the whole privacy issue?

That's what my doctors did as well. Never had a problem.

During my shadowing experiences, I never left the doctor's side unless the doctor had to do a pelvic exam (that was literally the only time I would step out, understandably). Aside from that, the patients were (usually) nice and allowed me to stay and listen; I acted professionally and never had an issue with it. In fact, at some point a woman turned to me during an interview and asked "why aren't you asking me any questions?" because she thought I was a doctor as well.

Not all doctors introduced me as a "student" but most did. In the ER I shadowed in, a LOT of patients seemed to think I was a doctor, even though on my ID card it clearly read "VOLUNTEER". I eventually learned how to say "I am not a doctor" in Spanish.

 

[Cp22kjer]

I've seen a lot during shadowing that would probably violate a ton of regulations. It's all a matter of personal preference of the doc to determine how much liability he/she's willing to risk. There might be a millionth of a % chance that shadowing will cause a problem, but some docs just aren't willing to take said risk. And others just use it as an excuse. Like others have said, just keep trying. Most of us have been rejected in similar ways.

Exactly. I shadowed 2 doctors out of a group practice and then asked their other partner about shadowing and he said no due to HIPPAA.

So two of the docs in the same place/practice were fine with it and one wasn't. I also think the HIPPAA excuse is used as a kinder way to say "no" or " I don't want observers" by some physicians.

One of the ER docs I shadowed just threw a white coat on me and told every patient I was a student. Its funny how that white piece of clothing will make everything OK.

 

[Chocolate Bear]

Exactly. I shadowed 2 doctors out of a group practice and then asked their other partner about shadowing and he said no due to HIPPAA.

So two of the docs in the same place/practice were fine with it and one wasn't. I also think the HIPPAA excuse is used as a kinder way to say "no" or " I don't want observers" by some physicians.

One of the ER docs I shadowed just threw a white coat on me and told every patient I was a student. Its funny how that white piece of clothing will make everything OK.

Haha yeah.

A couple of my docs just told everyone I was a student doctor (the offical title of med students), and one said, "This is a young Dr. _____, and he'll be getting a feel for clinical practice today."

Most of my mentors just told me "It would be better if you didn't see this one--patient might not like it" or "This one's gonna be gross...you can go in there for me if you'd like!" The latter translated into, "I'm draining an ass abscess and examining for STDs. For the love of God I wish I was a CPA for just like 5 minutes!"

 

[rajaholick]

I was shadowing a doc at a family practice a few years ago, and for a while there was an intern doing his time there.
So once the doc I was shadowing was kind of busy and told the intern (male) to go in there and do the history and told me to go in with him.
We walked in to the patient's room and the patient (70 year old female) just looked at us and said "no....no no no".
We walked out of the room and just laughed for a minute or so, her reaction was priceless...
(obviously we didn't know it was a personal visit until she rebuffed us so vehemently)

 

[Cp22kjer]

Most of my mentors just told me "It would be better if you didn't see this one--patient might not like it" or "This one's gonna be gross...you can go in there for me if you'd like!" The latter translated into, "I'm draining an ass abscess and examining for STDs. For the love of God I wish I was a CPA for just like 5 minutes!"

Right on! Do we shadow the same docs/places? Haha I feel you. I can't wait until I have a better understanding of it all. Shadowing has been a big motivation for me.

 

[engineeredout]

both of the docs whom i shadowed asked every patient if it was ok for me to be in the room during the appointment
doesn't that effectively get around the whole privacy issue?

Same with me. I did my shadowing at a teaching hospital directly connected to a medical school though so the attendings were probably more used to it.

Actually, I should probably add that I was a volunteer at the same hospital, and for that I had to sign a bunch of HIPAA forms anyway, so maybe thats why I never had an issue.

 

[MossPoh]

I just got a HIPPA certification spiel and signed a bunch of paperwork. Out of common courtesy the doctor asked each patient if it was ok. They always said yes. I think it is more of a crutch for people that don't want to go through the paperwork. If you talk about the patient outside of that instance or with that physician then it becomes a problem. There is no imaginable damage done by standing there while they look at a scar or talk about diarrhea.

 

[toast861]

I am actually shadowing one of the Assistant Professors at my local med school. Because the practice is affliated with the school, the consent to treat form that patients sign includes a clause that students/residents/etc can be present. Thus, any patient I see at the clinic has already legally consented that I can be there. Same thing goes when I go shadow surgeries and hospital rotations, any consent to treat from includes the student clause because it is a teaching hospital.

 

[COMedic2Doc]

Ahh, the great HIPPA misunderstanding that plagues nearly every profession. I agree with Tired, talk with the doc if you can or just keep on finding another office until you get a "yes". There are educational guidelines within the HIPPA rules, but many don't understand them, and some will require forms to be signed or training to be done.

 

[MossPoh]

HIPPA is a convenient excuse. After taking the little exam the only thing I remembered was to not talk about patients or look up their personal information. It was like an hour of answering those two questions over and over again.

 

[123165]

I have had to sign paperwork some places, and not in others. The FP I shadowed asked every patient beforehand if I could observe. THe only "no" I had was a psych. I even watched pelvic exams with consent.

The ID physician just introduced me as student, and so did the pediatric gastro.

I recently have been talking to a surgeon's office, and I am set to watch a surgery. I was specific in telling them I was a pre-medical student. The office called Friday and told me that I needed to contact the hospital I was observing at (large hospital) and see about signing consent forms. She suggested that because I was a resident it should be no problem.

I don't know where she got the idea I was a resident. I went to the hospitals web site and cannot figure out who to contact. I may just cancel today. Any advice?

 

[Chocolate Bear]

I have had to sign paperwork some places, and not in others. The FP I shadowed asked every patient beforehand if I could observe. THe only "no" I had was a psych. I even watched pelvic exams with consent.

The ID physician just introduced me as student, and so did the pediatric gastro.

I recently have been talking to a surgeon's office, and I am set to watch a surgery. I was specific in telling them I was a pre-medical student. The office called Friday and told me that I needed to contact the hospital I was observing at (large hospital) and see about signing consent forms. She suggested that because I was a resident it should be no problem.

I don't know where she got the idea I was a resident. I went to the hospitals web site and cannot figure out who to contact. I may just cancel today. Any advice?

Well, if it were me, I'd go through the hassle of contacting everyone necessary to sign the forms and get in there to see the surgery. Make sure you reiterate that you're a pre-med undergrad student (I assume), so it's all legit. You wouldn't want to have someone find out you're not what they thought, in the middle of surgery, and freak out on you!

But it's often difficult for pre-meds to get into the OR, so I'd be willing to put in a little effort to not let this one slip away.

I hope you make it into the OR.

 

[COMedic2Doc]

I have had to sign paperwork some places, and not in others. The FP I shadowed asked every patient beforehand if I could observe. THe only "no" I had was a psych. I even watched pelvic exams with consent.

The ID physician just introduced me as student, and so did the pediatric gastro.

I recently have been talking to a surgeon's office, and I am set to watch a surgery. I was specific in telling them I was a pre-medical student. The office called Friday and told me that I needed to contact the hospital I was observing at (large hospital) and see about signing consent forms. She suggested that because I was a resident it should be no problem.

I don't know where she got the idea I was a resident. I went to the hospitals web site and cannot figure out who to contact. I may just cancel today. Any advice?

Whatever you do, don't cancel this opportunity. Although it may be difficult to find the right person, be persistent. Since you are invited, some ideas might be the Surgery Schedule Coordinator or the Educator of the Surgery Department to see what forms they have. If they have a main Education Department try calling them and asking them. These are just a few ideas that I have regarding this, perhaps someone else can chime in.

 

[pietachok]

I am not going to have the popular opinion on this thread, but that might be because few of you have spent much time on the patient side of this.

Have you been hospitalized as an inpatient at a teaching facility?

Residents, fellows, and "students" with poor bedside manner tend to feel they have the right to come inspect you without even introducing themselves in great masses when you are unable to defend your rights (if you are pediatric, elderly, intubated, or otherwise unable to communicate well). HIPAA is supposed to let patients know who will receive their private health information--so clearly this is not a HIPAA violation if you are standing right there and the patient is disclosing information in front of you...but you may underestimate the feeling of subordination many people have to their physician. YOU are on track to being a doctor, it doesn't have the same sense of power or awe to you because it is attainable--for many people, that is an extreme position of authority and power, and they are in one of the most vulnerable positions of their life. They share things with their physician they may not even share with their spouse. SO, when that physician walks in the room and asks, "do you mind if ____ watches?" a large percentage of patients will not feel comfortable declining. THAT IS NOT OK. It is also not ok for patients to simply be told that a premedical student is a medical student and that they will be watching an exam, procedure or other medical event. Physicians who are doing that are violating their patients' trust. There are plenty of WILLING patients who will let you observe them VOLUNTARILY. If you shadow a physician and he/she does not introduce you to each/every individual and/or you do not ask permission to witness the private medical moments of each patient you see--shame on that doctor and shame on you. That is an important lesson you should be learning, and an important lesson you are missing.

Initiate your clinical exposure by doing something useful rather than simply "shadowing." Volunteer at a hospital or assist in a research project--become a useful element in these patients' lives rather than just a voyeur. I think the concept of shadowing fails to protect so many patients' rights.

I was an "interesting case" as a child--I had a one in fifty thousand defect. Everybody here would have thought it ok to "shadow" a physician to gawk at my unique ailment and progress...how many of you would have thought to ask me if it was ok?

 

[Semicolon]

I am not going to have the popular opinion on this thread, but that might be because few of you have spent much time on the patient side of this.

Have you been hospitalized as an inpatient at a teaching facility?

Residents, fellows, and "students" with poor bedside manner tend to feel they have the right to come inspect you without even introducing themselves in great masses when you are unable to defend your rights (if you are pediatric, elderly, intubated, or otherwise unable to communicate well). HIPAA is supposed to let patients know who will receive their private health information--so clearly this is not a HIPAA violation if you are standing right there and the patient is disclosing information in front of you...but you may underestimate the feeling of subordination many people have to their physician. YOU are on track to being a doctor, it doesn't have the same sense of power or awe to you because it is attainable--for many people, that is an extreme position of authority and power, and they are in one of the most vulnerable positions of their life. They share things with their physician they may not even share with their spouse. SO, when that physician walks in the room and asks, "do you mind if ____ watches?" a large percentage of patients will not feel comfortable declining. THAT IS NOT OK. It is also not ok for patients to simply be told that a premedical student is a medical student and that they will be watching an exam, procedure or other medical event. Physicians who are doing that are violating their patients' trust. There are plenty of WILLING patients who will let you observe them VOLUNTARILY. If you shadow a physician and he/she does not introduce you to each/every individual and/or you do not ask permission to witness the private medical moments of each patient you see--shame on that doctor and shame on you. That is an important lesson you should be learning, and an important lesson you are missing.

Initiate your clinical exposure by doing something useful rather than simply "shadowing." Volunteer at a hospital or assist in a research project--become a useful element in these patients' lives rather than just a voyeur. I think the concept of shadowing fails to protect so many patients' rights.

I was an "interesting case" as a child--I had a one in fifty thousand defect. Everybody here would have thought it ok to "shadow" a physician to gawk at my unique ailment and progress...how many of you would have thought to ask me if it was ok?

Ouch. This makes me feel pretty bad.

Although I want to point out that honestly, while shadowing doctors in the ER, I did try to make myself useful; I would take time out to visit patients' rooms and ask if they would want anything (food, drink, pillow, blanket, nurse, doctor, whatever have you). I actually did feel bad just following the doctor around and not doing more, and I'm sure that plenty of others here felt the same as well.

In terms of patient privacy, if I felt that it was an uncomfortable/sensitive situation, I would usually ask if it would be better for me to step out or I would voluntarily step out myself.

I am very sorry to hear about your past and your experiences and I sincerely hope that you are doing well and will continue to be. However, I still feel that shadowing is an important part of clinical exposure; it allows one to see the doctor-patient relationship firsthand and to see both the positive and negative aspects of medical care today as well as the various types of cases seen today, from typical to severe. This kind of exposure can give a student a good, or at least a better, perspective of what they are attempting to pursue.

 

[beachblonde]

I am not going to have the popular opinion on this thread, but that might be because few of you have spent much time on the patient side of this.

Have you been hospitalized as an inpatient at a teaching facility?

Residents, fellows, and "students" with poor bedside manner tend to feel they have the right to come inspect you without even introducing themselves in great masses when you are unable to defend your rights (if you are pediatric, elderly, intubated, or otherwise unable to communicate well). HIPAA is supposed to let patients know who will receive their private health information--so clearly this is not a HIPAA violation if you are standing right there and the patient is disclosing information in front of you...but you may underestimate the feeling of subordination many people have to their physician. YOU are on track to being a doctor, it doesn't have the same sense of power or awe to you because it is attainable--for many people, that is an extreme position of authority and power, and they are in one of the most vulnerable positions of their life. They share things with their physician they may not even share with their spouse. SO, when that physician walks in the room and asks, "do you mind if ____ watches?" a large percentage of patients will not feel comfortable declining. THAT IS NOT OK. It is also not ok for patients to simply be told that a premedical student is a medical student and that they will be watching an exam, procedure or other medical event. Physicians who are doing that are violating their patients' trust. There are plenty of WILLING patients who will let you observe them VOLUNTARILY. If you shadow a physician and he/she does not introduce you to each/every individual and/or you do not ask permission to witness the private medical moments of each patient you see--shame on that doctor and shame on you. That is an important lesson you should be learning, and an important lesson you are missing.

Initiate your clinical exposure by doing something useful rather than simply "shadowing." Volunteer at a hospital or assist in a research project--become a useful element in these patients' lives rather than just a voyeur. I think the concept of shadowing fails to protect so many patients' rights.

I was an "interesting case" as a child--I had a one in fifty thousand defect. Everybody here would have thought it ok to "shadow" a physician to gawk at my unique ailment and progress...how many of you would have thought to ask me if it was ok?

You make a valid point in that permission should be obtained from patients when a pre-medical student is shadowing. I do think, however, that actual medical students should not be denied the right to be in an exam room because they are gaining knowledge that they need to have. I think that patients should be informed that they are at a teaching facility, and hence student doctors will be in the room, and if they don't like it they can go elsewhere. I don't want my medical education to be stunted because some middle aged man doesn't want to discuss his GI problems in front of a young adult female such as myself.

I can say this because I've had several experiences myself as being the patient with the very interesting case on the peds ward. I remember once in the hospital there was a constant stream of med students and residents parading in & out of my room because I had the "worst" case of disease X the attending had ever seen. Certainly I wasn't asked if all these people could come prod me, but it was a teaching facility and they were learning. Such is life.

I do think shadowing is the best way to get a solid idea of what a doctor does, but only if that person can shadow for an extended period of time. Simply being in an office or hospital from 2-3pm 1x/week isn't sufficient, you need to follow that doctor around as close to full time as you can get. While volunteering and research can be valid ways to gain clinical exposure, it's simply not the same as actively observing a physician at work. I volunteered at a hospital, and it was the least relevant "clinical" activity I had when it came time for me to decide to apply to medical school.

Certinaly none of this applies to HIPAA, though. Any doctor who tries to tell students they can't shadow due to HIPAA regs is either 1) lazy, 2) lying, or 3) woefully misinformed. I've done what feels like a million HIPAA trainings in my life, and I can promise you that students are allowed to shadow, so long as they promise to follow some rules.

 

[Chocolate Bear]

I do think shadowing is the best way to get a solid idea of what a doctor does, but only if that person can shadow for an extended period of time. Simply being in an office or hospital from 2-3pm 1x/week isn't sufficient, you need to follow that doctor around as close to full time as you can get. While volunteering and research can be valid ways to gain clinical exposure, it's simply not the same as actively observing a physician at work. I volunteered at a hospital, and it was the least relevant "clinical" activity I had when it came time for me to decide to apply to medical school.

Thanks for saving me the time, as I couldn't agree with you more!

 

[pietachok]

Well, research doesn't need to be behind a microscope. I do clinical research, and I'm like the doctor's right hand.

I do agree that it is important for those interested in medicine who have not had a strong medical background/exposure to "shadow"...my point is that shadowing shouldn't actually be *shadowing*...you really should be doing more than acting like a shadow of the physician while you are there observing. There are tasks you can accomplish to make yourself useful in the process of your observations, and that makes your presence far more respectful.

And with regards to being in a teaching hospital...
...how many pediatrics patients are asked when they are being admitted if it is ok with them? And everybody who is admitted through an ER by ambulance? And nobody ever feels pressure to choose discomfort versus quality of care? Keep this in mind.

I realize that there isn't a clean and easy resolution to this--some people will always be vulnerable in the teaching process--just don't dismiss this as such a simple, "ok" part of the process. Many of them emotionally will never forget their experiences that easily, even though they are rationally very glad that you are learning how to care for them.