Medical Students in the Exam Room

Absolutely not. In fact, I try to get as many of my doctors as I can who are professors at a teaching hospital. I really enjoy watching the young students go through their paces.

One thing, that's really noticable to me, is the way the students handle a human body, relative to how the MD does.

My Doc is very gentle. Yesterday, the student ( a female ) wasn't! I wonder why.

Inexperience? If the doc were a really good teacher, he would "call" her on that!

Experience. She'll learn to be more gentle and you're helping her get there.

Good point!

Do you think I should have said something?

My regular MD, when taking my blood pressure, always holds my arm straight out. Yesterday, when the med student went to take the BP, I held my arm straight out and she grapped my arm and said to make it loose like a noodle!

In that position, my BP was somewhat lower!

I suppose if they are there to learn how to practice medicine, that should also include 'bedside manners', as well as the technical, clinical stuff. Therefore they should have been (gently) corrected. My current dentist is very newly qualified, and she's so gentle I've pratically fallen asleep during fillings.

I don't know what is happening now, but about 30 years ago, I met a woman who was a social worker. Her job, in a medical school, was to teach "bedside manner", empathy and caring to medical students. At the time, she said that she was one of the first in the country to have a position like that. I wonder if there are people now who teach teach those sorts of things now to med students.

I would not object to a medical student being present. However, after a surgical proceedure, I received a bill from a doctor I had never heard of. Upon asking the staff of the doctor who performed the surgery, I was told to go ahead and submit it to my insurance company. If they paid, fine. If not, no problem, it would be written off. The mystery MD was just there as an observer!

kirsten- Are you sure that the doc wasn't an "assistant surgeon". For many procedures, surgeons keep a backup doc in the operating room. I really don't know what they do, though!

One of the jobs I had during college summers (I was an English major) was a two week stint as "camp nurse" for a local Girl Scout Day camp. I was not a nurse, but I had a First Aid Certificate which met the American Camping Requirements.

Mostly a camp nurse deals with minor cuts and scrapes. Mostly. One camper started her day by gashing the back of her hand trying to play mumbley-peg. The cut obviously needed stitches.

I applied a pressure bandage and loaded Kimmy in the car with instructions to keep pressure applied "to remind the bleeding to slow down".

Of course we had to wait in the emergency room--since it was early in August, Kimmy drew a brand-new, fresh-out-of-med-school-resident.

This guy grabbed Kimmy's hand, slapped a window of gauze around the wound and took out an enormous neede. Naturally Kimmy started crying. I asked the resident to wait a minute and explained to Kimmy that the window of gauze would keep the site clean. Further, it made it easier to pretend that the stitching was going to happen to someone else--and things that happened to other people didn't hurt as much.

This was back in the '50's when the Golden West reigned on the television screen. I took a hunk of gauze and explained to Kimmy that the ER didn't come with bullets to bite, but she could bite down on the gauze just and that would make the pain much less.

Then I asked her to tell the resident to go ahead. Both the injection for the pain killer and the stitching (six stitches) were uneventful and quiet. It is impossible for a child to yammer when biting down on a mouth full of gauze.

The resident took me aside and asked where I'd done my nurse's training. Obviously, I'd had a terrific course in handling juvenile patients.

Interns, residents and other beginners are bound to be clumsy at first. They are juggling new information (and life and death matters) and this preoccupation makes it difficult to focus on patients-as-people.

I figure that they might as well practice on me--after all what else am I doing for humanity while I'm stretched out on that hospital bed?

I found this:

http://www.afmc.org/HTML/programs/review/medicaid/asst_surg.asp

This is the protocol for paying an assistant surgeon in Arkansas.

When my daughter was delivered, my doctor stood by and watched a brand new student deliver the baby. The he proceeded to pick up a giant pair of scizzors and waved them through the air, he needed them to cut the cord I guess. She slapped his down and whispered not to show me them, I might pass out from fright. I laughed, I had forgotten I was his 'first' and he was so nervous. It definatly made the moment even lighter.

Perhaps...but I certainly thought it odd that he was not concerned about being paid for his "services."

Funny question since I had this experience. When I was pregnant with my first child, being a little more shy, I thought the whole birthing episode would be embarrassing for me. Seeing you are not at your best and the parts of your body exposed with all sorts of goop, etc. would be a bit uncomfortable for me. However, once I was in labor my whole outlook changed. The doctor asked if I minded a young male student doctor observing and helping out. My opinion was anyone willing to help is more than welcome. The whole world could be there if they could help get this huge thing out of me. I also welcomed a student doctor in my second labor. They were actually quite helpful in talking with you and so forth and were truly interested in the whole process.

Observer?

Why should he/she be paid, then?

In some respects, the med student shows more concern for what the patient has to say about his/her illness. It's all news to the student and all
"old news" to the attending MD!

*L* That reminded me of what my parents told me. My Dad falls asleep in the chair at the dentist's office, whereas my Mom has to be practically scraped from the ceiling.



I know they do at the university here. In fact, there was an article in the paper about it a while back. It was an interesting contrast in how different generations were taught because the med student was the daughter of a doctor trained in the "old" ways. They profiled each one about their different approaches to patient care regarding bedside manner.



Unbelievable! It's stuff like this that keeps insurance rates high. Did you submit the bill? I would have contested it.


To answer the initial question, it depends on the situation. Unless it's something intimate (yes I'm STILL shy about that stuff!), I likely wouldn't have a problem. One time in E.R., there was a student accompanying the E.R. doc. The bad part was, the E.R. doc misdiagnosed me! I was told I had acid reflux when it turned out to be gallstones. Made me wonder how many other things he got wrong. Still, I guess my symptoms seemed classic to the E.R. doc, so I suppose it gave him a chance to illustrate that to the student, but it would have been better if the student had also seen that there are other possibilities.

I also recall assisting with a bone marrow collections when I was a student (in the health care field). I wasn't the one doing the collection, just helping with the retrieved specimen. Almost every single collection was done or attempted by a med student who had never done one before! Eeep! If I needed one, I don't think I'd let a student do it. This one girl was so small and she really didn't have the confidence one needs in these situations and gave up. Being small didn't help since I've seen male doctors of a fair size put all their muscle into screwing in the collection apparatus into the patient's hip bone. There were times I couldn't help think it was a good thing the patient couldn't see what was happening! But I knew they felt it. That part of the process is apparently quite painful.