Medical students

@ericmacson

To answer your questions:

Yes, there was a post that I was tagged in and responded to. I can’t find it anymore either.

At first I didn’t say anything to my doctor, at the time during the exams it didn’t seem appropriate for me to say what I wanted to in front of everyone given what was going on. After the third time though, I did ask my doctor if I could speak with him in his office and it was weird, I didn’t want to come off as rude but once I started I critiqued all three exams and didn’t stop talking until I was done. To my amazement he had several follow up questions and its hard to describe but I felt pretty good about the conversation. He also told me that instead of keeping it all bottled up that I should’ve spoken up during the exam because that is the feedback the soon to be doctors need to hear.

@ccm93,

Glad to hear it - good for you! I’m glad he responded well with real interest and encouraged you to continue your suggestions on your later visits. You might want to stay on a roll and make more suggestions to your other doctors and their med students. Bravo!

Eric, MD

Does anyone know if supervising doctors are compensated for allowing student doctors into their practice?

How about doctors in teaching hospitals, are they compensated for mentorin/training students?

@Srgfgahs In the United States, generally no, supervising doctors are not compensated for allowing student doctors into their practices. However, at teaching hospitals and clinics that are directly affiliated with medical schools, they can charge somewhat higher fees.

Does anyone know if supervising doctors are compensated for allowing student doctors into their practice?

How about doctors in teaching hospitals, are they compensated for mentorin/training students?

In my left breast, I've had a fibroadenoma for a few decades now. About 20 years ago, I was referred to a breast surgeon at a cancer center. He walked in with 5 medical students and asked if they could observe. There were two students who were male.

I didn't look at any of them while he was doing my breast exam even though they were standing really close. They all didn't do a breast exam but the doctor asked me if I would let them feel the lump and I let them. While the students were feeling the lump, the doctor was asking me about having it removed and tested for cancer. I told him it hasn't appeared to change in the past 15 years and it was first noticed when I was 20. He said cancer could be hiding in it or behind it.

It wasn't as bad as I thought. I had my left breast uncovered the whole time until they left the exam room. I don't know then if I would have agreed to additional breast exams, now I may have.

This would be slightly embarrassing to me, but I’d try to be understanding, they need to learn somehow.

I wouldn’t mind. I actually go to a teaching hospital. And like DaphneKL said, they need to learn somehow

They need to learn but you shouldn’t have to pay for their educational experience. When the students come in it is a teaching session and I am the study subject. Really it’s no different than having paid models for teaching. I think there needs to be a paradigm shift in how teaching hospitals operate.

They need to learn but you shouldn’t have to pay for their educational experience. When the students come in it is a teaching session and I am the study subject. Really it’s no different than having paid models for teaching. I think there needs to be a paradigm shift in how teaching hospitals operate.

@Srgfgahs We’ve agreed on a lot and I respect your position. You’ve said this before and I disagree (respectfully). You’re still getting medical care, and you have the option of not having medical students there for exams. If you have insurance, it’s moot anyway. They bill the same for an exam whether med students are present or not. Not an issue for me Having med students in an exam (to a reasonable number). Obviously it s not for you. Whether insurance is paying or if you’re paying out of pocket, you can refuse to have med students examine or observe. You have that right, even in a teaching hospital.

FWIW, a med student saved my wife’s life when a doc wasn’t available.

@ericmacson

Speaking of medical students, am I wrong being annoyed with my recent Cardiologist appointment? Had 11am appointment for a routine echoCardiogram and doctor's visit. At 11:20, brought into small echo room, besides the echo operator, she is accompanied by two “students”, they observe the procedure, plus I was asked to have them try a bit on me as well, fine with me. Sent back to waiting room,,, waited a while…brought in to small doctor exam room…waited 15 minutes for first person who takes the usual blood pressure/weight information ….waited at least 15 minutes, then visited by a PA student, from local college with a marked lab-coat from the school. Also fine with me. She gives me the most extensive rundown of questions and testing from my corotid arteries , down to my toes… took FOREVER. Then she says “the doctor will be in shortly”…. another 15 to 20 minutes went by….. by now it is 2:15pm, she comes in and says, he is running late maybe another 15 minutes….. then comes in again, says maybe another 10 minutes. I told her this is ridiculous, I'M LEAVING…which I did at 2:30. He calls me on my cell phone, at 2:45 while I'm in the nearby supermarket in the produce section, and apologizes, and basically gives me a consultation over the phone.

Speaking of medical students, am I wrong being annoyed with my recent Cardiologist appointment?

No, you’re right being annoyed. It happens, fortunately your doc called after you gave up and justifiably left. Sounds like too many intermediaries tried to cover for the unavailability of the doc.

@Rigel

The doctor’s attention is split between teaching and providing care. I don’t care how good they are when their attention is split like this you do not necessarily get the best of care.

Even with insurance you still pay. You pay your copay and you pay higher premiums to subsidize the cost of teaching medical students.

As for care, my wife had a kidney removed due to kidney cancer. A resident under supervision removed it and supposedly also the adrenal gland. Except he missed the adrenal gland! And the preeminent urologist didn’t catch it because he was teaching instead of practicing medicine.

The adrenal gland kept showing up in follow up scans and the Urologist kept denying its existence. Finally, a review board was convened. After viewing multiple scans $150 each by the way, they concluded the resident just couldn’t find it despite the urologist being present. So yes. I just don’t think you necessarily get the same level of care and you shouldn’t pay, via insurance, copays or self pay when you are used as a teaching model for medical students.

We will just have to agree to disagree on this one.

@ericmacson

Speaking of medical students, am I wrong being annoyed with my recent Cardiologist appointment? Had 11am appointment for a routine echoCardiogram and doctor's visit. At 11:20, brought into small echo room, besides the echo operator, she is accompanied by two “students”, they observe the procedure, plus I was asked to have them try a bit on me as well, fine with me. Sent back to waiting………………………. He calls me on my cell phone, at 2:45 while I'm in the nearby supermarket in the produce section, and apologizes, and basically gives me a consultation over the phone.

@KennyT,

Nope. Sounds like you were justified. Glad he called to try and make up.

Eric, MD

@Srgfgahs Sorry about the experience and bad medicine you and your wife had. Hope everything turned out positive for her (and you) in the end.

@Rigel only time will tell. Her new oncologist surgeon from a non- teaching hospital has left the decision to remove or simply keep a watchful eye on things up to her. The endocrine specialist at the teaching hospital advises against surgery because of the scar tissue and the major surgery nature of removing the adrenal gland now.

So she gets scans every 6 months to monitor the nodule‘s size on the adrenal gland for change. She is going to see the teaching hospital one last time then continue follow up with the non-teaching folks.

This is all because of a distracted doctor not paying attention while supervising a resident. If it were the only bad experience we have had at a teaching hospital I would write it off as a one off event. But 3 less serious incidents have occurred over a 10 year period.

I would advise that if you DO get seen by students that a separate doctor, not the teaching doctor, repeat the exam without the students present. Their attention will be on your health and not teaching. In other words keep the actual exam separate from the teaching experience.

The endocrine specialist at the teaching hospital advises against surgery because of the scar tissue and the major surgery nature of removing the adrenal gland now.

What's that mean? Sounds like a fancy way of telling you it will cost YOU a fortune to have them fix what they screwed up.

@roscoe or it means they are concerned that they might find cancer in it and get sued for incompetence. In their minds, better to leave it where it is.

That said, she was lucky given that her kidney was ‘obliterated‘ (their description not mine) by the cancer. They only found cancer in a vein outside of the kidney. Even her new doctor says scans are a viable option.

But not being able to find the adrenal gland seems like a rookie mistake. Too bad the teaching doctor wasn’t a practicing physician that day. Live and learn. Teaching hospitals aren’t all that they are made out to be.

How do you feel about an inexperienced young medical student looking on while you are being examined? Or even doing the examination under the supervision of an experienced doctor?

My sub's first PCP was a final year student. Not young by any means, but still not officially licenced. The next few visits had a new student each time. They all had another experienced doctor that they had checking what they did.

It was the final one who said that he was worried that my sub was maxed out on his cardiac meds. Which I asked his cardiac doctor we had an appointment with later that day. He is no where near the max.

We changed PCP's after that experience. A student (final year or so) should not speak out if they are not sure. It is very off putting and scary to a newer, inexperienced patient.

My sub's first PCP was a final year student. Not young by any means, but still not officially licenced. The next few visits had a new student each time. They all had another experienced doctor that they had checking what they did.

It was the final one who said that he was worried that my sub was maxed out on his cardiac meds. Which I asked his cardiac doctor we had an appointment with later that day. He is no where near the max.

We changed PCP's after that experience. A student (final year or so) should not speak out if they are not sure. It is very off putting and scary to a newer, inexperienced patient.

@MissStress,

Was the licensed PCP in the room with you? Did he/she say anything about the student’s incorrect statement about the drugs? Or say anything to you afterwards? I’d recommend asking the student and PCP about the correct dosages for your sub while still in the exam room. If he corrects the MS, fine, but if they both are in error, I’d consider leaving. Also, at times a specialist may well use certain drugs from their field at different or higher dosages than your non-cardiologist PCP is comfortable with. That happened quite often in my anesthesia practice where we were accustomed to using highr anesthetic drug dosages than most if not all other doctors were experienced or comfortable with. The MS could very well have thought he was being accurate, but that’s why your experienced licensed PCP is there to correct him/her.

Eric, MD

The MS could very well have thought he was being accurate, but that’s why your experienced licensed PCP is there to correct him/her.

@ericmacson …and that’s the problem. There was a licensed doctor in the room but they were in teaching mode not practicing mode.

That licensed doctor should have done the exam over without the student in the room so they could be in practicing mode.

Humans are I’ll equipped to do two things at once.

Was the licensed PCP in the room with you? Did he/she say anything about the student’s incorrect statement about the drugs? Or say anything to you afterwards?

@ericmacson No the licensed PCP was not in the room so I do not know if they even know of the comment. To have made comments about a specialty he was not experienced in just lost my confidence in his ability to assist us in this health journey.

After that experience with that particular health center I got my sub a different, closer to us, PCP. One we'd had previous positive experience with.

This PCP has not done anything that has gotten me worried about her knowing or not knowing what is best for my sub.

My last physical (wellness exam) I was asked if I minded if an intern would be in the room, as there was one shadowing the NP today…………I said I didn't mind and thought maybe it would be more thorough…………nope. Which is dumb, wouldn't that be a perfect opportunity for new person. Just show them how to quick do as little possible and then on to some more money……………

While in grad school, one of my visits to the student health service was provided by an intern from the university's medical school. It was my second physical there and he was very thorough with considerable periods of me being totally exposed for all of his probing and examination.

When I was 17, I got seen by a medical student before my regular doctor. Nobody told me he'd be there, but I'm guessing my father signed off on it. He was a young guy, maybe only 5 or 6 years older than me and I remember talking with him about college plans.

What stuck with me most though, was the checks he did that my doctor never did. He checked the reflexes in my knees and elbows, which despite being depicted in nearly every piece of media concerning doctor's visits, I had never had done to me. He also took my temperature via my armpit. My doctor never took my temperature in any way as far back as I can remember.

He did the usual eyes, ears, and throat checks and auscultated my chest and back before my doctor came in and repeated all his usual checks. He then continued with a normal exam while the student watched, sometimes explaining what he was doing to him in detail and allowing him to repeat the checks. The student got to watch my doctor do a hernia check, but he wasn't allowed to repeat it.

The exam dragged on longer than usual due to all the repeated checks and explanations, but I never felt uncomfortable about the student being there, not sure I could say the same if he'd been a woman.

I'll try to keep this short.

I was in for an annual skin exam. I was seen by a new NP who was about 45-50 years old. She had me remove clothing and gave me a small gown. I placed the gown across my lap. She scanned from head to belly, then had me stand up. I stood up and placed the gown on the exam table. She quickly asked me to turn around so she could scan my back. She asked me to then face her and asked if I had any concern as she pointed, but didn't look, at my groin. I told her I had a severe recent itch at the tip of my penis, she looked. Then asked me to sit down. I sat on my gown as we discussed the findings of her examination. She then asked me to get dressed and schedule a follow up at the front desk.

As I left the exam room there were 6 interns filing in the doors to the exam room area. I then made three appointments that were pending in my record with the front desk folks. As I was leaving the building my phone rings, it's the NP asking me to return to the clinic area.

She brings me into another room, with another younger assistant sitting at the desk making busy work on the computer. The NP asked if I would allow the interns to take turns doing a full body skin exam. She said the clinic wasn't booked for another hour and they could use the help, if I was available.

I agreed and was examined by 4 of the 6 interns. All four were female resident student interns. The NP told each one that she was a fly on the wall and would not help, only grade their examinations.

I’ve been to the doctor and have been asked if I minded if a medical student observed. I appreciated being asked ahead of time. However, I have to admit that if I knew it was a full exam, or even an exam in which I had to disrobe, I would definitely decline if it was a female. I specifically make appointments with male clinicians if it involved any sort of disrobing and thus, Id only be comfortable with a male medical student being present.

Honestly I enjoy someone's fresh perspective, and also enjoy helping a doctor gain experience in something, so I'm always more than happy to have a medical student in on the exam

A wise doctor once told me that there should be a sign engraved over the front door of every hospital – “Abandon modesty all ye who enter here”. I've spent a fair amount of time in hospitals and care centers in the last few years, and I've gotten to the point where I don't care who's in the room or who is doing the exam. There have been numerous instances where students were involved and if I can help their education, I'm glad to do so.

On a semi-related note, the best student experience I ever had was in college. I knew a pair of twin gals who were both nursing students. One day they mentioned that they had been told to practice giving enemas and weren't particularly looking forward to it. In a burst of total selflessness (yeah, right) I offered to be their practice patient. Of course, it didn't take long before everybody was both giving and receiving and they both discovered they loved enemas. We had a lot of fun.

Seen so many times at 10 years of age. The very first time the nurse who took me for an examination asked if I was afraid of doctors or shy or not. I said no and she began to praise me. I lied because I was taught that doctors should not be shy. I don't know if my "no" played a role or not. Groups of students were 4-5 people. Those who visited me on examinations were always girls, they were probably studying to be pediatricians, in those days it was quite difficult to meet a male pediatrician