lol I don't think she did it because I'm such a great med student. She did it because as you say they were bogus consults and she was busy. I totally agree she should be eyeballing the patient for herself, the fact that she didn't made me uncomfortable which is why I posted to see if this happens elsewhere (apparently not).
I'm sure it does happen elsewhere. That wasn't my point, my point was that if I were you, I'd get my name off that chart in the off chance any chicanery was going on because fraud has been committed.
However except for the physical exam, the attendings rarely fact-check all the info we present, aside from labs which they usually but not always look up themselves, so I don't see how this is different than relying on students for the physical, in terms of putting the patient at risk. Also the treating team is on top of the patient.
IMHO it depends on the attending and the student/resident. I've had attendings who I *knew* knew what the labs were, but were checking to see if we were telling them the truth. Others wouldn't have the first clue about how to use the EMR. As you mature, you get to know whom you can do what with. I have had students that I trusted and others that I knew I had to double-check what they told me. I'm a bit of a micromanager so even for the trusted ones, I'd probably double check anyway.
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In the end, most of the info students collect is either non-contributory or the answer will be different when the attending asks, so its not necessary for the attending to repeat the entire ROS, H&P and examination. A 4th year student is probably better, at this point in time, doing a neuro exam, than I am.
I've only seen a consult be turned down once and it spiraled into a quite entertaining 20 minute argument between two senior residents (neuro vs. uro, guess who consulted who). Afterward the attending whispered to the resident "it's never worth it, it's easier to just do the consult". So I think there is a culture here of not turning down consults.
In most places, consults aren't turned down. In a community practice, you rely on consultants for referrals. Piss someone off and there goes those patients (I remember at a community hospital where we rotated as medical students I had to keep straight which medicine group the surgeons liked that week
🙄 when it came to requesting consults). Even in academics, most of the time its not worth it to engage in arguments. I used to be traumatized by one of our surgical oncologists who insisted on consulting med onc for his post-op pancreatic patients. This, despite the fact that path wasn't back, that the patient could be seen once discharged, despite the fact that we told him over and over again. Med Onc would argue again and again and we would have to say, "look we totally agree with you. We get it. But arguing doesn't help...this attending will not get off our backs until the consult is done. Have your attending talk to ours if you want something different done."
So yes, bogus consult aside, most aren't turned down and even for the bogus ones, I'd be a little uncomfortable as a student if the attending were charging for a visit they never made and relied solely on my consult.
