Respect Patient Autonomy?

[AnatomyGrey12]

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Is this the case just as a med student or the case in residency too. Is our fascination malignant surg/OB residencies like our fascination with serial killers (in that you will most likely never meet one) or is resident abuse widespread.

If your definition of malignant is getting stuff thrown at you, then yes it’s exceptionally rare. Most people don't have such a strict definition of malignant. There are definitely malignant OB/Surgery programs, and they aren’t necessarily unicorns.

 

[jurassicpark]

As a medical student/resident do you just take that **** or can you report it to someone? I did not sign up to get stuff thrown at me. Especially not by doctors...

As others stated, doesn't happen often no or at all. I was in residency > 10 years ago, not yet time for my colonoscopy though. But it was on the cusp when a lot of the old-school attendings were still around. The throwing thing was not tolerated even then, though a few years prior it was.

 

[Mass Effect]

As a medical student/resident do you just take that **** or can you report it to someone? I did not sign up to get stuff thrown at me. Especially not by doctors...

You report, report, report. You report it to your school and to the chief of service. That BS doesn't fly anymore. Docs get suspended, fired, and/or sanctioned by the medical board.

Had a coworker who thought she could handle one of these kinds of people alone who got her head grabbed and yanked hard enough that she had some cervical fractures. She ended up being fine and was only out a few months before coming back to work, but it could have very easily gone a different way for her.

I don't know, cervical fractures doesn't sound like being fine to me.

 

[calivianya]

You report, report, report. You report it to your school and to the chief of service. That BS doesn't fly anymore. Docs get suspended, fired, and/or sanctioned by the medical board.



I don't know, cervical fractures doesn't sound like being fine to me.

As far as I’m aware she didn’t have any neuro deficits or residual pain when she returned to work. Lucky would probably have been a better word choice than fine.

 

[Mass Effect]

As far as I’m aware she didn’t have any neuro deficits or residual pain when she returned to work. Lucky would probably have been a better word choice than fine.

Yeah, and don't forget the psychological ramifications. Seems ripe for a serious case of PTSD.

 

[Detective SnowBucket]

If your definition of malignant is getting stuff thrown at you, then yes it’s exceptionally rare. Most people don't have such a strict definition of malignant. There are definitely malignant OB/Surgery programs, and they aren’t necessarily unicorns.

Throwing things is not my definition of malignant. I'm pretty soft so take it from there.

 

[hallowmann]

In clinic recently, I entered an exam room to talked to the patient before presenting to my attending in their office. The nurse confirmed with the patient that they were fine speaking to a medical student. As I entered and greeted them, they took one look at me, asked me if I was the medical student, and loudly exclaimed, "No!" They were sitting on the exam table and threw the clipboard onto the counter top as I exited shell-shocked.

TBH, my school has not taught us how to react to these kinds of situations only teaching us that we must respect patient autonomy. I did bring up the matter with my attending immediately before they went to see the patient, but was kind of disappointed in their response. The attending brushed off my concerns speculating that the patient probably did not hear the nurse ask whether they were fine speaking to a medical student. I confirmed with the nurse that they asked the patient about speaking with a student. I dropped the matter with my attending, but expect that it will likely happen again in my medical school career and/or beyond due to how toxic the political environment has become.

I am seeking advice on how to proceed when it happens again as I felt powerless as a MS, suppressing my urge to respond to the patient accordingly. I don't believe it warrants reporting to the clerkship director or school's Student Affairs Office, but am open-minded to one or both possibilities based on the advice given.

Thank you.

You did exactly what you should have done. Say "OK" and peace out. The attending should have been a bit more supportive, but honestly this is a regular occurrence. Don't worry about it and as others have said be happy that you have less work. Not everyone is going to love or like you (and anyone) for a myriad of reasons.

agree with this sentiment. it happens, move on from it. i don't even think about it or remember which patients said it lol. it would be too taxing to think about every negative patient encounter.

The one of many that I remember was a manic patient that repeatedly motioned that he was going to kill me because of my ethnic group and religion. I remember him for a few reasons, (1) I saw him daily for like a month, (2) by the end of my time there he loved seeing me, and (3) the day after I left the unit, he apparently wrestled an antisocial patient off of a psychotic patient that got on the antisocial patient's nerves resulting in the psychotic patient getting strangled on a way too acute unit. He was apparently discharged a few days later, and we have Depakote and Zyprexa to thank for it.

 

[Anti-PD1]

It’ll happen as an attending as well. Patient comes in through ED or transfer, may not want care from you or your hospital in particular.

 

[gyngyn]

Mayo Clinic has published on this: Limits to Patient Preferences

ACP Journals

Here's OHSU: Honoring diversity when patients act on racist beliefs