Patient Intimate Exposure

[MBVT]

First, I am impressed with the effort so many put into achieving their goals to become a physician, starting at such young ages. It gives one hope for the future.

As a non-medical person I am hoping that some here can help me understand certain basic protocols for student shadows that I have not been able to get from my local hospital. Having learned that they have students as young as 14 observing surgeries in the OR, I posed several very specific questions so as to understand what high school student shadows are given access to. Regretfully I have not been able to get any policy feedback from the hospital beyond students wear badges saying they are students and that patients can refuse students if they so choose. Those things I already knew.

What I asked is whether high school students are in the OR during the patient prep or only after patients have been draped and are ready for surgery, whether there are restrictions on what kinds of surgeries students are allowed to observe, and generally whether high school students are allowed access to patients when patients are intimately exposed, be the patient awake or anesthesized.

Does their lack of answer mean there are no restrictions whatsoever? I hope not because I am generally disposed to helping students learn, but not so much that I'd allow a 14 year old girl to watch me be catheterized. My guess is that common sense likely prevails and that patient privacy is protected but not being able to get any answers from the hospital has me wondering.

Thanks for any insights you can provide. Good luck with your careers.

---

Members don't see this ad.

 

[AttemptingScholar]

I've shadowed a lot, and hospitals have their own rules for what is acceptable, so you won't get a hard-and-fast rule on an international forum. That being said, a patient always has the right to refuse shadows. If it makes you even a tiny bit uncomfortable, definitely don't be afraid to say no.

The point of shadowing is to give potential doctors an idea of the day-to-day of medicine because TV shows exaggerate its excitement. The 8-hour lung-piece removal I watched was cool, but the enema I watched (different patient) was more the point. Students who like the exciting parts but not the normal parts might be better suited to different professionals, and that's the end goal of shadowing. If you don't want that, or only want students to access a portion of your time as a patient, just say so. Any clinician who puts up a fuss is being severely unprofessional and any student who does probably shouldn't be a doctor.

Shadows almost always have undergone HIPAA training and understand the gravity of your treatment. You don't need to worry about that. If it's just feeling uncomfortable, then just say so.

Edit: Doctors also have their own rules about shadows, so the hospital can't comment to that. More experienced doctors will probably have more shadows.

Ask me anything about my time shadowing.

 

[MBVT]

Thanks AttemptingScholar, your comment about doctors having their own rules may be partly behind the hospital's reluctance to answer my questions. I hadn't thought about that.

As I said I am generally disposed to saying yes, but I have my limits as do most of us. If I am saying yes to students observing my surgery I want to understand what it is I am saying yes to. Part of the issue why I wanted to understand the hospital's policies is because patients are not always in a position to say yes or no. For example if I am in a car crash and end up with emergency surgery, do they let students in to observe, or the same while in the ER and being examined for injuries? These are questions of limits and whether minors have patient exposure limits placed on them.

 

[AttemptingScholar]

Thanks AttemptingScholar, your comment about doctors having their own rules may be partly behind the hospital's reluctance to answer my questions. I hadn't thought about that.

As I said I am generally disposed to saying yes, but I have my limits as do most of us. If I am saying yes to students observing my surgery I want to understand what it is I am saying yes to. Part of the issue why I wanted to understand the hospital's policies is because patients are not always in a position to say yes or no. For example if I am in a car crash and end up with emergency surgery, do they let students in to observe, or the same while in the ER and being examined for injuries? These are questions of limits and whether minors have patient exposure limits placed on them.

As cool as it would be to shadow in emergency surgery, I have not heard of a student shadowing in there. My shadowing experience in the ER was always with conscious patients who gave a clear, yes-or-no answer. Usually, any family with them is also given the chance the weigh in. Any surgeries/procedures I've watched, I met the patient before they were given any medications. I have never heard of a student being allowed to shadow in a way that doesn't get patient consent. We understand how much of a concern that is.

Here is an example of a hospital's expectations and allowances for shadowing in the emergency room, which does not include (or even mention) surgery. Shadowing » Department of Emergency Medicine » College of Medicine » University of Florida

Here is the AAMC's guide on student shadowing. It is not legally binding, but is the closest thing to a national agreement on anything: https://www.aamc.org/download/356316/data/shadowingguidelines2013.pdf

You always have the right to ask what the student intends to shadow. Your comfort is more important than their experience. They have four years to shadow and you are in the hospital for a much shorter time.

 

[dpmd]

Thanks AttemptingScholar, your comment about doctors having their own rules may be partly behind the hospital's reluctance to answer my questions. I hadn't thought about that.

As I said I am generally disposed to saying yes, but I have my limits as do most of us. If I am saying yes to students observing my surgery I want to understand what it is I am saying yes to. Part of the issue why I wanted to understand the hospital's policies is because patients are not always in a position to say yes or no. For example if I am in a car crash and end up with emergency surgery, do they let students in to observe, or the same while in the ER and being examined for injuries? These are questions of limits and whether minors have patient exposure limits placed on them.

I would begin with the assumption that a student shadowing will be able to observe any activity without limit and then give instructions on what you wouldn't want them to see. I don't have any young students, but if I did they would be present for any case I do that the patient doesn't refuse including procedures on the genitalia (unless the student or their parent asked not to). They would also be given the opportunity to do any hands on thing the hospital allows me to because that is what my surgical mentors did for me when I was young (though being eye surgeons there wasn't much intimate potential). Granted the rules are more strict now in terms of hands on,but that doesn't mean they aren't possibly going to be watching the catheterization and prep process. I am trying to understand your concern. If it is strictly that you are worried about the young person not acting in a professional manner, let me reassure you that sort of thing would not be tolerated. But it sounds like you are more concerned with your own exposure in which case I don't think the age of the audience really needs to matter. Would several adult medical and nursing students seeing your genitalia be any less problematic to you than just one high school student? What about if one of those nursing or medical students is who is tasked to practice catheter insertion on you?

 

[WheezyBaby]

I would begin with the assumption that a student shadowing will be able to observe any activity without limit and then give instructions on what you wouldn't want them to see. I don't have any young students, but if I did they would be present for any case I do that the patient doesn't refuse including procedures on the genitalia (unless the student or their parent asked not to). They would also be given the opportunity to do any hands on thing the hospital allows me to because that is what my surgical mentors did for me when I was young (though being eye surgeons there wasn't much intimate potential). Granted the rules are more strict now in terms of hands on,but that doesn't mean they aren't possibly going to be watching the catheterization and prep process. I am trying to understand your concern. If it is strictly that you are worried about the young person not acting in a professional manner, let me reassure you that sort of thing would not be tolerated. But it sounds like you are more concerned with your own exposure in which case I don't think the age of the audience really needs to matter. Would several adult medical and nursing students seeing your genitalia be any less problematic to you than just one high school student? What about if one of those nursing or medical students is who is tasked to practice catheter insertion on you?

I personally feel there is an appreciable difference between someone just shadowing, regardless of age, and someone who has committed themselves to a health profession by enrollment in school and is being held, at minimum, to the professional standards of the institution. I would still offer a shadower the full opportunity to observe / participate to their ability, but I'd be much more understanding of a patient being more restrictive of what they're willing to offer that shadower (as compared to a health professions student) who very well might never even end up being a health professional

 

[dpmd]

I personally feel there is an appreciable difference between someone just shadowing, regardless of age, and someone who has committed themselves to a health profession by enrollment in school and is being held, at minimum, to the professional standards of the institution. I would still offer a shadower the full opportunity to observe / participate to their ability, but I'd be much more understanding of a patient being more restrictive of what they're willing to offer that shadower (as compared to a health professions student) who very well might never even end up being a health professional

I would absolutely understand the patient being restrictive. I just wouldn't restrict without them saying something.

 

[WholeLottaGame7]

Thanks AttemptingScholar, your comment about doctors having their own rules may be partly behind the hospital's reluctance to answer my questions. I hadn't thought about that.

As I said I am generally disposed to saying yes, but I have my limits as do most of us. If I am saying yes to students observing my surgery I want to understand what it is I am saying yes to. Part of the issue why I wanted to understand the hospital's policies is because patients are not always in a position to say yes or no. For example if I am in a car crash and end up with emergency surgery, do they let students in to observe, or the same while in the ER and being examined for injuries? These are questions of limits and whether minors have patient exposure limits placed on them.

You are welcome to request whatever you want, but keep in mind the simpler your requests are, the more likely they are to be accommodated. For example, it would frankly be a little ridiculous to say "it's OK if you have a student shadow you for my operation, but they have to step out or close their eyes when they put the Foley in." A) Medical people don't care about your junk. B) If the thought of a 14 year old high school student (who you will never see again) running home and telling her friends "teehee I saw a PENIS today teehee" bothers you, just say "I'd rather not have anybody shadow you today." C) (B) is totally fine, I wouldn't care a bit about kicking a student out. It's a privilege for HS/college students to be in the hospital and observe things, not a right. It's a little different for nursing students and medical students, because they're paying for an education and if you go to an academic hospital, it's part of the understanding that you will have students participate in your care.

 

[MBVT]

Thanks for the thoughtful replies. It has been helpful. I should have added that I live in a small town rural setting and so it is far from assured that I would not run in to that high school kid who shadowed in the OR at the local hospital. It is hard for either side of the equation to be anonymous in small towns.

In my mind I do differentiate between adults enrolled in a medical, nursing or similar school and minors who hope someday to be medical professional. I am willing to help high school students...to a point. I suspect high school student shadows are more mature on average than their peers, but intimate exposure to opposite gender minors just seems wrong nonetheless. Given the vagaries of what a given doctor would allow, for me the starting point would be saying no, but in fairness I would say why I am saying no which gives the medical staff an opportunity to clarify their policies and maybe turn my no into a yes.

 

[AttemptingScholar]

Thanks for the thoughtful replies. It has been helpful. I should have added that I live in a small town rural setting and so it is far from assured that I would not run in to that high school kid who shadowed in the OR at the local hospital. It is hard for either side of the equation to be anonymous in small towns.

In my mind I do differentiate between adults enrolled in a medical, nursing or similar school and minors who hope someday to be medical professional. I am willing to help high school students...to a point. I suspect high school student shadows are more mature on average than their peers, but intimate exposure to opposite gender minors just seems wrong nonetheless. Given the vagaries of what a given doctor would allow, for me the starting point would be saying no, but in fairness I would say why I am saying no which gives the medical staff an opportunity to clarify their policies and maybe turn my no into a yes.

I absolutely get what you are saying. The distinction between enrolled students in a health program and those who are not yet is important, maybe more important (I would think. but this is absolutely up to interpretation) than age. A 17-year-old in a nursing program probably (1) understands more about what is expected due to bioethics curricula and (2) has a larger clinical requirement that needs to be met than a 21-year-old starting med school in a year.

If things like age and gender matter to you, then enforce them. This is especially true if you are concerned about anonymity. Your comfort comes before their experiences. In medicine, it's important that things like age and gender don't matter to doctors and nurses, so rules probably will not be made on those grounds. Hope this helps.

 

[DokterMom]

As a patient, you could also simply say "That side of the drape only, please" for the sensitive bits. That's a very reasonable request and one that's easily accommodated.

 

[MBVT]

I absolutely get what you are saying. The distinction between enrolled students in a health program and those who are not yet is important, maybe more important (I would think. but this is absolutely up to interpretation) than age. A 17-year-old in a nursing program probably (1) understands more about what is expected due to bioethics curricula and (2) has a larger clinical requirement that needs to be met than a 21-year-old starting med school in a year.

If things like age and gender matter to you, then enforce them. This is especially true if you are concerned about anonymity. Your comfort comes before their experiences. In medicine, it's important that things like age and gender don't matter to doctors and nurses, so rules probably will not be made on those grounds. Hope this helps.

Thanks. I suspect you will be an empathetic doctor, and so good luck to you. Age and gender may not matter to doctors and nurses (except when they themselves are patients....how many female doctors and nurses would allow a male to do their mammogram for example or would allow a 14 year old boy to observe them being catheterized?) but sometimes it does matter to patients. Women are pretty good about speaking up but men tend to be too embarrassed to speak up because they're not supposed to care about such things.

In any event the advice here has been good and I do better understand where the medical profession is coming from. The discretion at the individual doctor level makes it understandable why my local hospital couldn't answer my questions. And believe me I really do prefer to help students, and I do respect the effort being made by students. I just have some opposite gender limits, in particular with young teens or those not enrolled in an actual nursing or medical program.

 

[MBVT]

As a patient, you could also simply say "That side of the drape only, please" for the sensitive bits. That's a very reasonable request and one that's easily accommodated.

Yes, that is an easy way to go about it, and it can add a touch of humor to defuse tension or embarrassment.

 

[InTypical]

First, I am impressed with the effort so many put into achieving their goals to become a physician, starting at such young ages. It gives one hope for the future.

As a non-medical person I am hoping that some here can help me understand certain basic protocols for student shadows that I have not been able to get from my local hospital. Having learned that they have students as young as 14 observing surgeries in the OR, I posed several very specific questions so as to understand what high school student shadows are given access to. Regretfully I have not been able to get any policy feedback from the hospital beyond students wear badges saying they are students and that patients can refuse students if they so choose. Those things I already knew.

What I asked is whether high school students are in the OR during the patient prep or only after patients have been draped and are ready for surgery, whether there are restrictions on what kinds of surgeries students are allowed to observe, and generally whether high school students are allowed access to patients when patients are intimately exposed, be the patient awake or anesthesized.

Does their lack of answer mean there are no restrictions whatsoever? I hope not because I am generally disposed to helping students learn, but not so much that I'd allow a 14 year old girl to watch me be catheterized. My guess is that common sense likely prevails and that patient privacy is protected but not being able to get any answers from the hospital has me wondering.

Thanks for any insights you can provide. Good luck with your careers.

I'm 17 now and started shadowing medical procedures at 15, and since then I have seen about a dozen different procedures ranging from a carpel tunnel surgery to a heart procedure that I can't remember the name of anymore. From what I've been told the patients will sign and agree to it (optional I think) Don't take me up on that, not completely sure, but as a shadow, the closest I got to helping the surgeon in the room was 'handing him the trash can' which I almost failed at 0_0. For seeing exposed patients (nudity I assume you mean), not uncommon, I've seen my fair share of breasts and a peek at genitals but nothing more, I don't honestly think it is any different from seeing the inside of a person (yuck!). You won't have to interact with 'lil kids' shadowing in the same room, but I mean it is optional, usually the nurses will explain to me some details I won't know about what is going on, the main surgeon basically focused on what he was doing (shadowed two different ones). One time though, I met this really nice anesthetic guy who let me see more into the actual operation, (this was a laminectomy), by getting me a little stool and stand next to where he was sitting (where he anesthetized the patient) so I could partially see what was happening inside the patient. Most staff just keep to themselves so you can do that if you want. Just remember we are TEN times more nervous than anyone else in the room because most of the time we have no idea what is going on.

 

[AttemptingScholar]

I'm 17 now and started shadowing medical procedures at 15, and since then I have seen about a dozen different procedures ranging from some carpel tunnel surgery where they slit the crease in your hand to a heart procedure that I can't remember the name of anymore. From what I've been told the patients will sign and agree to it (optional I think) Don't take me up on that, not completely sure, but as a shadow, the closest I got to helping the surgeon in the room was 'handing him the trash can' which I almost failed at 0_0. For seeing exposed patients (nudity I assume you mean), not uncommon, I've seen my fair share of breasts and a peek at genitals but nothing more, I don't honestly think it is any different from seeing the inside of a person (yuck!). You won't have to interact with 'lil kids' shadowing in the same room, but I mean it is optional, usually the nurses will explain to me some details I won't know about what is going on, the main surgeon basically focused on what he was doing (shadowed two different ones). One time though, I met this really nice anesthetic guy who let me see more into the actual operation, (this was the another spinal procedure), by getting me a little stool and stand next to where he was sitting (where he anesthetized the patient) so I could partially see what was happening inside the patient. Most staff just keep to themselves so you can do that if you want. Just remember we are TEN times more nervous than anyone else in the room because most of the time we have no idea what is going on.

Thanks for your experiences, InTypical. It seems like OP is particularly concerned about nudity. Would you say you felt it was particularly inappropriate or obscene? Did you talk to other shadowers, and did they (or you) talk about it in a respectful (or not respectful) way?

 

[InTypical]

Thanks for your experiences, InTypical. It seems like OP is particularly concerned about nudity. Would you say you felt it was particularly inappropriate or obscene? Did you talk to other shadowers, and did they (or you) talk about it in a respectful (or not respectful) way?

Didn't seem inappropriate to me, I pretended to be "professional" whenever the nurses had to move a partially/naked patient.I think for the most part everyone helping with the patient does a good job at covering the parts they aren't working with. Where I shadow I'm pretty sure there is a max to how many shadowers can be in the surgery room during a procedure since it is smaller, but I never had that problem since I was the only one every time.

 

[MBVT]

Thank you InTypical for sharing your experiences. That you were allowed in the OR at age 15 affirms what I learned occurs in my local hospital.

Attempting Scholar, yes you are correct. It is the intimate exposure that I was trying to understand better. At issue for me is whether true informed consent is being given. There is a difference between saying a student will be present (which most patients would take to mean a medical school student) and saying a high school student will be present. My guess is that most facilities would not make that clear.

Some patients would be fine with high school shadows in the OR. Others not. I suppose I'd say OK for a male high school student but not a female as I just don't think it is appropriate to be intimately exposed to teenage girls. Just the way I was raised.

 

[MBVT]

A followup question for your InTypical. Were you ever introduced to the patient before surgery, and if so what were you introduced as? Did patients know you were in high school rather than medical school? Thanks

 

[Toutie]

Honestly, I don't even think you (specifically) should be pursuing any shadowing experiences at this age. You are obviously far too immature. I realize you are just in high school, but you are far too obsessed/uncomfortable with the possibility and rules of intimate patient exposure at this point in your life. Go to college, grow up a bit, and then look into these types of experiences.

edit...disregard this post. I'm stupid. See my post below.

 

[Toutie]

I think this individual is an adult patient (somewhat justifiably) concerned about their privacy when young students are observing their care, not a student interested in pursuing shadowing opportunities.

Oops...you know what, you're right. After reading back through the thread, I see it is a patient rather than a HS kid. I guess as the thread progressed over the weeks, I lost track of the original point. Sorry.

 

[InTypical]

A followup question for your InTypical. Were you ever introduced to the patient before surgery, and if so what were you introduced as? Did patients know you were in high school rather than medical school? Thanks

I never met a patient before or after a surgery. Patients aren't given information on who exactly will be shadowing their surgery as far as I'm concerned

 

[AttemptingScholar]

A followup question for your InTypical. Were you ever introduced to the patient before surgery, and if so what were you introduced as? Did patients know you were in high school rather than medical school? Thanks

I did meet a patient before a surgery, though I believe this is my doctor's preference rather than the hospital's. At the time I was between high school and college, but I believe I was introduced as a volunteer, which I why I was at the hospital in the first place. When I observed non-surgical patients this same summer, I often corrected people who introduced me as a college student (though technically I was one) because the volunteer program was primarily filled by high schoolers and I didn't want them to think I was 22 and starting med school in the fall.

 

[MBVT]

Thank you InTypical, Attempting Scholar and others for your honest replies. It does not surprise me that different physicians and facilities handle the informed consent matter differently.

A suggestion to those of you who will go on to become physicians and a plea to those of you who are already there, please take informed consent seriously. Allowing a patient to think the student is a medical student when in fact they are in high school is not informed consent. That most patients will never know the truth does not make it right.

Instead of hiding behind a generic consent form where the word student is buried on page 2 in small print and is undefined, introduce the student to the patient beforehand and disclose their educational status. Most patients would appreciate the courtesy and if presented in a positive manner many will consent. For example "John is in 11th grade at such and such high school. He hopes to become a surgeon and I have found him mature and professional beyond his years. I hope you will allow him to observe your surgery. It will be a valuable experience as he pursues his education". Taking the high road usually pays dividends down the road. At a minimum it builds trust.

I totally understand why high school students and physicians here don't think it matters if 15 year old boys are observing intimately exposed female patients or 15 year old girls are watching intimately exposed male patients. It is apparently part of everyday life in the OR and so none of the players give it much thought. What gets forgotten is that it falls far outside the societal norms that exist outside of the hospital environment and as such it should not be assumed that all patients are OK with it. To the extent there has not been true informed consent the patient has not agreed to it. Maybe the patient is OK with it, maybe not, but it should be the patient's choice.

Thanks again to those here who helped me understand this issue. I wish you well as you pursue your medical careers. I am not concerned about myself as I now know to ask the pertinent questions but it does give me pause to know that most physicians and hospitals don't think I'm entitled to the respect that informed consent entails.

 

[WholeLottaGame7]

Thank you InTypical, Attempting Scholar and others for your honest replies. It does not surprise me that different physicians and facilities handle the informed consent matter differently.
...
Thanks again to those here who helped me understand this issue. I wish you well as you pursue your medical careers. I am not concerned about myself as I now know to ask the pertinent questions but it does give me pause to know that most physicians and hospitals don't think I'm entitled to the respect that informed consent entails.

I think you're going a little overboard on the theatrics here. "Most physicians and hospitals" are very concerned about providing informed consent, because it is the ethical (and legal)ly correct thing to do.

But "informed consent" is a somewhat nebulous topic and does not mean the same thing to everybody. For you it means knowing the exact educational level of people who are shadowing. That is fine. It is your right as a patient to know who is going to be present for the procedure. But many people do not care to get that detailed, especially with regards to people not involved in their care. So to expect every physician and hospital to initiate that level of detail would be a little unusual. It is probably most common for it to be handled one of two ways (or both). Most physicians will introduce people who shadow them. At bigger, academic places, the procedural consent forms will also say something generic along the lines of "your procedure may involve or be witnessed by students and trainees."

 

[MBVT]

WholeLottaGame7, if doctors introduce shadows in a way that does not infer they are medical students when they are not then I'd be OK with the onus being on the patient to pursue informed consent further if they choose when those introductions are made. If the doctor uses terminology such as student doctor which infers medical student, then there is no informed consent unless that person is in fact in medical school. There is no circumstance where the word doctor can be used in conjunction with a high school kid. A doctor did that to me once when he brought a young woman in to observe an annual physical. It was only afterwards that I realized she wasn't in medical school.

When patients are being given forms to sign prior to surgery, they are always presented as consent for the procedure and consent to bill insurance. There is never mention that the forms contain anything else. Few patients read, let alone understand, these lengthy consent forms. Yes the blame can be on the patients for not reading the forms and asking questions, but at the point the forms are given most are worried about the surgery itself and assume the doctors and other staff are giving them all of the pertinent info. The debate here seems to be on whether noting student observers is pertinent info. To some patients it is.

Where physicians focus on informed consent is in making sure the patient understands what the surgery is. That is of course the most important piece. If hospitals want to have minors in the OR however, then there is another piece to informed consent that should be addressed. Though everyone here seems OK with the patient declining observers, that can only happen if the patient understands that there will be observers.

 

[WholeLottaGame7]

If someone hints that a student is a medical student when they are not, then that is a problem. But, they could easily say "so-and-so wants to be a doctor one day," which has the word "doctor" in it, but does not imply that they are a medical student, and in fact implies that they are at a lower educational level (HS or college).

Anyway, I think we're generally in agreement on this but just differ on the details. I will just sum up by saying, as a physician, we have a lot of stuff to focus on and worry about, and remembering complicated rules about who can see what at what age can get confusing. Like I said earlier, the simpler the requests, the easier they are to abide by.

You seem very torn between protecting your privacy and helping students out by letting them observe, which is admirable, but you don't need to be. I get the impression that you'd be more comfortable just asking for no high school or college observers, but you're afraid you'll come across as an a$$hole or not a team player. Seriously, don't worry about it. It's your care, you can have what you want.

WholeLottaGame7, if doctors introduce shadows in a way that does not infer they are medical students when they are not then I'd be OK with the onus being on the patient to pursue informed consent further if they choose when those introductions are made. If the doctor uses terminology such as student doctor which infers medical student, then there is no informed consent unless that person is in fact in medical school. There is no circumstance where the word doctor can be used in conjunction with a high school kid. A doctor did that to me once when he brought a young woman in to observe an annual physical. It was only afterwards that I realized she wasn't in medical school.

When patients are being given forms to sign prior to surgery, they are always presented as consent for the procedure and consent to bill insurance. There is never mention that the forms contain anything else. Few patients read, let alone understand, these lengthy consent forms. Yes the blame can be on the patients for not reading the forms and asking questions, but at the point the forms are given most are worried about the surgery itself and assume the doctors and other staff are giving them all of the pertinent info. The debate here seems to be on whether noting student observers is pertinent info. To some patients it is.

Where physicians focus on informed consent is in making sure the patient understands what the surgery is. That is of course the most important piece. If hospitals want to have minors in the OR however, then there is another piece to informed consent that should be addressed. Though everyone here seems OK with the patient declining observers, that can only happen if the patient understands that there will be observers.

 

[grapp]

I've shadowed a lot, watched multiple surgeries and shadowed family medicine physicians and internal medicine particularly. I will go over how I went about doing it and hopefully you can learn a thing or two from my post. I volunteered at a hospital for a long time, I started introducing myself to the doctors a couple times and informed them I had the aspirations of becoming a doctor. After talking a few times, I asked what if they had students shadow them before.. The most typical answer was, yes. One of them didn't, but I still decided to ask anyways if they felt okay with the idea. I started shadowing an internal medicine dr. who was very interesting and his interpersonal skills were excellent. I felt like my personal skills were excellent, but I tried to pick up on what the doctors did and (not mimic) because that's not the right word... But, try to copy their demeanour and professionalism. At some point I branched out and before I knew it I had some emails, a few phone numbers; and was able to shadow several doctors. From this, I went on to ask some of them about surgery and suggested I was interested in this area particularly to see if it was something I could handle. Surprisingly enough all of them had the same recommendation. He was a general surgeon who practised in the same hospital, however; he didn't have any fellowships. I approached him after I got a brief description from some of the other physicians, we hit it off with a conversation and in the same conversation I asked him if I could shadow him sometime. He gave me his phone number, and his email and told me his procedure days at Thursday's. On Friday's is when he did his surgical work. I started out by watching some colonoscopies and some EDG's? (I think that's what they are called)... That went very well, so I contacted him first thing the next Monday morning to setup a shadowing session in the OR. He told me he would have to get permission from the OR director and the OR manager. I received an email a few days later and signed up. I had no clue what to expect, I was 17 at the time... I observed him do several lap colies (laparoscopic colosectomies? I believe? Then he had an open hernia repair, which was very invasive and I got to see a lot more than I had thought I would see. That surgery itself was 5.5 hours and made for a pretty long day. I haven't done many of them since because I have been pursuing my EMS career at the moment.

A couple tips:

1.) Look professional, polo and a nice pair of pants with a belt. Just don't overkill it, of course make sure your hygiene is on par too.
2.) Do what the doctor says and don't argue, I never had a problem with this but he did have to tell me to move once, of course I didn't hesitate.
3.) Pay attention, your in an operating room. God forbid, please don't be on your phone.
4.) Ask questions (depending on the physician) many of them like questions from students but not all.
5.) Don't get anywhere near the scrub table.
6.) Make sure to thank anyone for any questions you have, who knows; you could be working along side them someday.
7.) Don't talk too much, no one likes that.

This could honestly go on and on. I'm sure some people will think my whole story was unnecessary but I think it's important to see the process of what I went through. Some people may have completely different opinions or stories, but I hope having one to compare to helps.

 

[Winged Scapula]

Part of the problem is that the OP is sexualizing the encounter.

It's completely within his rights to refuse to have a student in the room but when the reason that he refuses female students is because he feels it's "inappropriate" for them to see adult male genitalia, he's making a judgment that onlythe student and/or his parents or guardians should. Medical procedures are not sexy

If someone comes to my office or OR intent on observing what I do want to day-to-day basis, once the patient has given their consent, it's up to the student to tell me if they would prefer not to see certain procedures but otherwise they may see anything and everything. Frankly, it's a good lesson for them to realize that just seeing breasts or genitalia does not make it a sexual situation.

Nonetheless this is a more appropriate topic, the discussion of informed consent, in the topics in healthcare forum where I will move it.

 

[MBVT]

Winged Scapula, thank you for your feedback. I agree that the larger issue is informed consent. My starting point was trying to understand the norms as concerns high school students and patient intimate exposure. Folks here answered my initial questions and also shed light on the perceptions of what constitutes informed consent.

You are correct that medical procedures are not sexy but the patient population ranges from the very modest to the totally non-modest, and being in a medical setting does not change those orientations. Some may not care if there are extra eyes in the room. Those that do can say no as has been discussed here. Either choice is OK so long as there is informed consent. My example of a young female student observing my physical was not informed consent because the doctor led me to believe she was in medical school. Once burned twice shy as they say.

 

[SBVT]

If you sign the typical generic surgical consent form the way they are written it means,

1) You allow anyone to do any procedure.
2) You allow anyone they want to watch.
3) You allow any picture or video of you they want.

Although the hospitals have additional policies and restrictions for all these items your consent form has NO restrictions concerning these. You have signed these rights over to the hospital. It’s like joining the military.

Most hospitals have a patient bill of rights explaining that you can reject students, observers, photography, etc. but they really don’t want you to exercise those rights. You can also reject the best doctor in the world and without your consent it’s assault. Patient rights are usually listed somewhere else and are not typically on the consent form.

Another thing that I have noticed in many blogs like this concerning patient exposure and privacy are comments like this…

"Medical people don't care about your junk."
"We have seen it all before."
"We’re all professionals."

So what! The medical staff doesn’t have anything the patient hasn’t seen before either! The patient is expressing their discomfort to you about being exposed; they’re not concerned about you blushing! It's not about you! These statements seem more like a bullying tactic to silence the patient. When medical and nursing students learn to do examinations and procedures, they usually draw the line at intimate exams. They either hire professional patients for this or do an “unconsented” exam on an anesthetized patient. If you’re all professionals and have seen it all before then being exposed to each other should not matter anymore than the patient being exposed to you. Why not have students do intimate exams on each other? That just doesn’t happen because then you would be the one who is uncomfortable. Double standard there.

Bottom line is you can reject unnecessary staff and observers and if you do agree to observers in the consent form you have turned that decision over to someone else.

 

[SBVT]

To preface this, I absolutely believe that patients have the right to refuse any procedure by any person. We should be transparent with our patients about what is going to happen to their bodies and emphasize their right to make these choices. Just want to clear up some misconceptions you seem to have.


I have used these type of statements before (perhaps worded a bit differently), but not in an attempt to minimize the patient's discomfort or bully them into silence. At least in my experience, patients tend to be concerned about exposure because they are worried we are judging them - how they look, that they have a condition they believe to be embarrassing, etc. That's my way of telling the patient that I'm not giving a second thought to whatever they're worried about beyond what's necessary to provide them with adequate medical care. But you're right, this idea could certainly be phrased with a little more empathy and understanding.


The difference is the power differential. As a patient, you have a right to refuse any involvement from any professional or student without any negative consequences (other than obviously choosing to seek care elsewhere or from another provider). While perhaps we can sometimes do a better job of emphasizing that right to patients, it is still there. As a medical student, I'm constantly worried that saying "no" to somebody who is my supervisor will result in a bad evaluation, a bad grade, and impact my future career choices. There is also a huge difference between being exposed to your colleagues, your friends, etc. who do not have a medical relationship or responsibility with you as a healthcare provider and someone who is examining you for the purposes of your healthcare. Would you feel more comfortable being examined by your physician and their team, or by your boss while all your coworkers are watching? Same idea.

Regarding "unconsented" exams on anesthetized patients...the only time I have ever done a sensitive exam on an unconscious patient is when the exam is relevant to the procedure I'm about to assist with. I spent some time on a colorectal surgery service, and many of those patients got rectal exams under anesthesia as part of their procedure. Similar situation when I was on gyn surgery. Typically the "exam under anesthesia" is listed on all the paperwork as part of the procedure and the patient is told about it. And frankly, if a student is going to be scrubbed in, they SHOULD BE examining the patient for safety reasons. If I'm going to be assisting by suturing with a needle and scissors, suctioning, cleaning up blood/drainage, etc. in a sensitive area, then I need to be aware of the anatomy and any unusual masses or growths so that I'm not damaging anything in the process. It's never something I'm asked to do just because, and never on a patient who doesn't need that exam done as part of the procedure.

I see your point about the power differential but there is also a power differential between patient and provider, even with a patient bill of rights.

 

[LADoc00]

I have an interesting perspective from both sides. I went to my primary care concierge doc for annual exec physical and he had a shadowing male doc from another country with him. He asked whether he could observe the exam and being the cool doc type of guy, I said yes before remembering my primary does this epic anal exam prostate ritual once a year. I could he see the foreign docs eyes literally bug out of his head at this likely thinking I was somehow gay as the rainbow.

So that was the first time I was thinking this shadowing thing has gotten of out control. Some of the primary docs in my community have like 19 year old attractive coeds following them around which would have sent my stress-o-meter to 11 out of 10.

I think it is interesting to see how medicine works, but parading entire classes who all carry cellphones through people in vulnerable states with their legs in the air or whatever is absurd. We dont have kids who are interested in joining the military jump on tanks and fire machine guns wildly in the air and we dont need teens strolling through and looking at patients' anal sphincters....this crap needs to end.

If you arent an actual medical student OR resident specifically at a TEACHING HOSPITAL, there should be no "observers". Modern medicine shouldnt be taking a cue from Bedlam Hospital and letting people stroll through facilities to get their rocks off.