shadowing and patients permission

[KS123]

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Ok, I had a weird experience today. I had an appointment with my GP this morning and when he walked in he had a student with him (pre-med student). I know the guy, we were lab partnes in o-chem and he is in my immunology class this semester! Anyway we say hello and I expect him to leave the room since we know each other personally and all, but he doesn't and the doctor just starts talking to me. So I have to say, "I'm kind of uncomfortable with this could you see me without an observer". I wasn't there for anything super personal, but it was awkward.

Anyway it just kind of made me wonder if there are rules about this sort of thing. I have shadowed before and the nurse would always tell the patient before we came in that the doctor was having a student follow him and would they mind if I observed. Most of them were cool with it, some said no. I assumed you had to get permission. But today nobody told me anything or asked if it was ok, they just walked in. I would have been fine with it if it had not been someone I knew. But it made me wonder about the asking first thing? Did the doctor I shadowed have his patients informed ahead of time because of ettiquete or do they have to get permission?

What do you guys think about this? I kind of think patients should be told a student will be with the doctor before they come in.

 

[TTSD]

While it would be the most corteuous thing to do, when shadowing a doctor it's hard for the doctor to keep asking "Is it alright for my student to observe?" especially if it's in a private-clinic setting.

I've been thrown off to multiple different doctors at the hospital when my primary one has to go to a private meeting with the admins, the other doctors have never asked patients if I could come in an observe them or doing procedures (and the patients would sometimes be naked). Then again, half of them were unconcious in ICU or they just thought I was another doctor.

 

[KS123]

When I was shadowing it was actually the nurse that asked. When they took the patient to the room, got their weight, BP, asked what they were in for etc they would say a student was following was it ok if I observed. When they handed the chart to the doctor they would tell me in the rare case the patient had denied permission. I know the docs are way to busy to keep up with that kind of thing, but I assumed the nurse or receptionist informed the patient and got permission. In a clinic setting anyway, I guess hospitals would be different. So it is not required I guess?

 

[TTSD]

I don't really know the official hospital rule on that.

As a VOLUNTEER, you always should knock and ask permission unless they're unconcious or asleep and whatnot. Though for shadowing, I guess it's the doctors responsibility though.

 

[Newquagmire]

When I shadowed, sometimes the physicians would ask and sometimes they would not. It was all very strange to me. At least once I voluntarily declined to follow into a room.

I was even more awkward when I followed a RN into a room to take preliminary data and she asked if I wanted to inspect the patient myself!

 

[MeowMix]

When I shadow, the MA/nurse usually asks before we get to the room. If not, and the doctor forgets, I introduce myself and ask if it's OK. I expect that not all patients will want me there. Also, I am usually asked to step out during male genital exams (I am female).

If I knew the patient personally, I would probably just leave the room for the whole exam.

I am sure that shadowing violates most HIPAA rules, so I try to make myself as unobtrusive as possible and unlikely to generate patient complaints.

 

[matthew45]

I've got a better one, the doctor I shadowed last year used to host MSIII's all the time. It was cool because I got to pick their brains and for the most part they were very cool. But....

So one day this girl MSIII is in the clinic, and the doc says "Ok Sarah (or whatever her name is) you and (me) go see this kid while I go down the hall." The kid was about 12, and the MSIII goes through her tripping, unsure examination of the kid, talks to him a little bit about his symptoms, then turns to me and says, "can you think of anything else to do?"

 

[VienneseWaltz]

When I shadowed, the doctor typically introduced me as a student doctor, which gave the patient an opportunity to say he or she wanted me to leave. If the doctor sensed the patient seemed apprehensive about having me there (most didn't care), sometimes he or she would ask directly if it was OK.

Whatever the policy, the person you knew should have immediately excused himself.

 

[Robz]

Almost everytime I shadowed the physicians introduced themselves and then introduced me as a student. Most of the time they asked the patient if they minded me coming in and if not they remembered in the next few moments. Sometimes there were patients that wanted their privacy with their treatment or procedures. An example of this is when I was shadowing a general peds physician and he had a 13 y/o girl that was in for a physical. Last thing a teen wants in a physical is a premed student poking around. (akward age anyways 🙂 ) I had absolutly no problems skipping a patient or two and I used that time to talk to the nurses that were working in the area. I think in the case of a fellow student shadowing your GP is odd in either he or the physician should have asked. Especially if you knew each other. Just my .02 and I think it is common courtesy.

 

[Mistress S]

I think it is really rude for a doctor to not ask the patient if he/she is comfortable with having unnecessary observers in the room. I also don't understand how that situation is HIPPA compliant. I work in a clinic and throughout the years we have had many student nurses, residents, and others in the clinic to observe patient visits; we ALWAYS ask the patient's permission before allowing others in the room, and respect their wishes. Since I am often the one taking patients back for their visits and setting them up for their appointment (BP, weight, etc), when I am in that situation I always ask the patient before the doctor or nurse is in the room to give them an opportunity to decline without feeling pressured. Very few do, and I feel the loss for the training doc or NP is small when compared to the importance of maintaining respect for the patient. Working in a reproductive health care clinic in an area near where I spent some of my high school years, I am also familiar with the experience of running into patients I know from outside the clinic, which is often doubly embarassing for them given the nature of the work we do. It seems to me that the ethical thing to do, and what I've always done, is to defer dealing with the patient directly whenever possible and to at least give them the option to see or speak with another staff member. I think your GP and the student were both very remiss in their handling of that situation.

 

[carrigallen]

obviously this is a big gray area in informed consent. I don't think it is as much of an issue in HIPAA because it simply limits healthcare information to those who need to know, ie at a teaching hospital, student doctors. The question is whether patient consent is explicitly required prior to introducing a med student, or even having a resident learn a new procedure. Certainly most patients sign off to be treated by "Dr. X / his deputy"...but i think it is still best to inform the patient when a new caretaker is involved.

As for the premed student story...i think the other student should have excused him/herself immediately, no questions asked. . The office visit is as much about patient confidence and trust as any physical exam.....clearly his presence was harmful.

 

[Mistress S]

It does seem like a HIPPA issue to me, the situation described (premed shadowing) does not include student doctors who are present as part of a training program and therefore have some need to be involved, but rather premed students who are not medical staff and have no reason to be involved with the patient or have access to their healthcare info (including the legally protected health history and examination), other than to satisfy their personal interest. Nor do many of these shadowing experiences take place in teaching hospitals anyway--often they are in private hospitals or clinics, where a student has obtained a doctor's permission to shadow him/her but not the individual consent of the patients that will be observed and whose private health information will be shared with the student. Involving unnecessary persons in a patient's health care should always require their prior consent. I am willing to concede a larger gray area when it comes to medical students and residents, whose "need" to be involved is more debatable and justifiable, than in the case of premed students who are involved simply because they want to view the medical profession and perhaps pad their resume and have no "need" to have access to a patient's private health records. There is nothing wrong with shadowing, as long as a patient feels comfortable with it and has had the opportunity to decline without pressure. Otherwise, it seems deeply disrespectful of the patient and a rather blatant violation of the laws that have been established to protect the privacy of a patient's healthcare information (i.e., HIPPA).

 

[Robz]

I would just like to add that out of the five or more physicians I shadowed since the HIPPA laws has been enforeced only one of them made a comment about it. They nicely asked that I sign a paper saying I was part of their office staff and I would follow the rules of confidentality. Maybe it was because I was shadowing peds that they asked this but I always made sure I had consent whenever I shadowed a physician. I think physicians are just now starting to realize all that needs to be addressed with the HIPPA statute.