Medical students

During my family medicine rotation, we'd have a bunch of guys in for Medicare wellness visits. Part of that is the prostate exam. My doctor would ask them for permission for me to feel their prostate after he would, and literally 100% of the guys asked agreed to let me examine them like that, which was interesting.

The prostate has a size scale from (if I remember correctly) 0-4. So after we'd both examine, in front of the patient I'd say what I thought the size was, and he'd tell me if he agreed or not. I was never all that good at it, honestly...a size 1 and a size 2 felt basically the same to me.

Since he had a female nurse practitioner, she generally saw all the female patients of OB/GYN types of things, but I did end up doing one breast exam on a lady and then discussing in front of the patient what I had felt. I remember she had fibrocystic changes, which I failed to appreciate! Her husband was there, who the week before I had done a prostate exam on, so I thought that was pretty interesting!

I suspect different med schools did it differently. In my case, med school in Oregon 1969-73, the entire second year had a physical diagnosis class. We had a text (DeGowin, if memory serves, or something like that) and had class three times a week. We went thru by region and/or organ system: ENT, chest, abdomen, neuro etc. Often a patient was brought in who exemplified a disease state and the instructor demonstrated. We had lab sessions that did often include practice sessions on other medical students. We paired up and practiced looking into ears, percussing chests, feeling for lymph nodes, spleens, auscultating hearts and so forth. The instructors rotated thru and helped. We did not do genital or rectal exams on one another tho. Those were left to us to practice on the wards and in clinics on patients. Standardized models or volunteer patients were not used at that time or in that setting. I can see the advantage. I still have a picture someone snapped of my partner and I auscultating one another.

I suspect different med schools did it differently. In my case, med school in Oregon 1969-73, the entire second year had a physical diagnosis class. We had a text (DeGowin, if memory serves, or something like that) and had class three times a week. We went thru by region and/or organ system: ENT, chest, abdomen, neuro etc. Often a patient was brought in who exemplified a disease state and the instructor demonstrated. We had lab sessions that did often include practice sessions on other medical students. We paired up and practiced looking into ears, percussing chests, feeling for lymph nodes, spleens, auscultating hearts and so forth. The instructors rotated thru and helped. We did not do genital or rectal exams on one another tho. Those were left to us to practice on the wards and in clinics on patients. Standardized models or volunteer patients were not used at that time or in that setting. I can see the advantage.

In the mid 60s, when I was in school we followed a similar system. I can't remember which textbook was used in our Physical Exam class. I have a copy of Bates in my library at the present time, but I believe that the one I have was published more recently. As @rayme stated, we didn't have standardized patients and we also practiced basic skills on one another, but I can;t remember whether that was required, encouraged, or whether we just did. Genital, rectal and female breast exams were reserved for patients on the wards, or when I had an externship with an internist.

I have had a complete physical by a regular doctor and a med student. The doctor would perform a part of the exam and then the student would do the same thing. They would take turns doing something and then the other (did this make sense?) Oh, well. The exam took them twice as long - over 30 minutes.

I have had a female nursing student present during a cystoscopy, a couple of years back at my urologist's (also female) office. Of course, I was asked if I would mind having a student present, and I assured them it was no problem at all. The senior nurse reviewed the numbing process, then had the rather attractive student insert a couple of numbing syringes into my penis and injected it as far into my urethra as she could. Then she took a clamp from the tray and clamped the end of my penis so that the numbing agent wouldn't run out. I was then covered with a towel, and the nurses left the room. In about 15 minutes, the nurses returned, along with my doc, who reintroduced the student, and said something like "let's get this party started!". My doc held my penis and carefully dropped the end of the cystoscope into it, I always marvel at how easily she does that, and how little discomfort I experience. Throughout the proceedure the student asked questions of the senior nurse and my doc, and was not in the least embarrassed or intimidated. They did the bladder wash next, to check for any rogue cells, then gave me a wash of antibiotic to prevent a bladder infection. I think that this was the first year that my doc had the proceedure on a screen, so all of us could see the inside of my bladder-loads of fun...at the conclusion, I was told that everything looked good, and she would call with the bladder wash results, and see me in another year.

Yes I would not mind at all in fact a couple of months go a medical student assisted with my pap smear it was very professional nothing bad or any complaints

I had a dermatologist whose practice was associated with the medical school and it was common to have student examine first. Then the doctor would come in and repeat the examination. I never cared about it. Students have to learn somewhere.

I don't have a problem with students trying exam skills out on me but I draw the line when students or residents are used to replace the attending physician.

Jds as you know your doctor will be a resident at a teaching hospital. I was a doctor in full as a first year resident. I did develop some subtlety as I got older and more experienced. I only had the attending the next morning.

Actually, the 24 hour on call hospitalists are attendings.

The hospitalists are a relatively new development. Since I did my training in the '70s they didn't exist then. The chief resident and attendings were available by phone. Infrequently they came in to help me out. Although it seems risky it was great training.

Med students sometimes used to help out at uni sports medicals. It was embarrassing one year when I vaguely knew 2 of them and they saw be naked.

Jds as you know your doctor will be a resident at a teaching hospital. I was a doctor in full as a first year resident. I did develop some subtlety as I got older and more experienced. I only had the attending the next morning.

I never had a problem with residents working on me with an attending present. And for some routine procedures, I was comfortable with a senior resident performing them alone. Now, the first couple of weeks in July.... that's another story.

The hospitalists are a relatively new development. Since I did my training in the '70s they didn't exist then. The chief resident and attendings were available by phone. Infrequently they came in to help me out. Although it seems risky it was great training.

One of my problems with hospitalists, as well as with many specialists (and especially their PA's) is that they often do not consult with the patient's primary care doc. I have seen some serious situations develop when meds were changed. There often is no coordination between hospitalists and mu

You're absolutely correct. I demand a single source for medications (non emergency). I've run into problems, even with group practices. The therapeutic philosophies of various doctors can be diametrically opposed. I refuse to be in the middle. An example is my serum potassium. I run low and get symptomatic when treated. I've had specialists and practice partners panic when I'm normal (for me),including refusing to discharge me from the hospital. They're treating a piece of paper and ignoring me - the best source for information about me available. I can see the same shit happening with a hospitalist or resident who has never meet me and knows nothing about me beyond the lab results.

. . . . I've had specialists and practice partners panic when I'm normal (for me),including refusing to discharge me from the hospital. They're treating a piece of paper and ignoring me - the best source for information about me available.

Absolutlely, @Jds4 med. It's amazing how many doctors continue to treat the patient out of a medical textbook, instead of listening to their patient. Patients live with their bodies 24/7/365 and most of them know when something is not right with their body. A little patience and active listening is all it takes. One of the things I like about most nurses is that they do listen to their patients. Many a tragedy has been avoided because a nurse listened when the doctor didn't.

I'm also the 'worst' kind of patient for many doctors. I'm the patient who knows basic medicine, studies what ails me extensively and demands the consultant doctor, not the authoritarian doctor. 'Doctor's orders' are merely a suggestion for me.

I've been running slightly anemic since 1966. I have never been treated and never took iron, mostly because I know my baseline and won't let some practitioner who has seen me once play with me to see what outcome they can produce.

Jds you are the kind of patient I treasure the most. I can't stand the patient who says "you're the doctor you tell me" when I ask for a history. I love to be a health consultant.

I actually wouldn't mind being examined by medical students. I have a body type that most medical students might never see, so having them understand what I look like might help encourage more education and less stigma.

Journey12^^^ Most medical trainees by the end of their studies including prac exams see just about EVERY body type.

I am transgender, and I highly doubt that most med students work with trans people.

Journey12--If its any consolation there should be no differentiation when it comes to medical assistance sought...Both ER units & ICU training being the obvious--just sayin.

Oh I agree, people should be treated as people first.

I wouldn't have an issue with med students examining me. I used to be a paramedic, and when you're a student, you're at the mercy of people allowing you to examine them, start their IVs, give shots, etc. The best way to learn as a student is to experience and do.

Besides, it could be rather fun... 😉

I would be fine with being examined by a medical student or students. Whether they are by themselves or supervised by a doctor it would not be an issue at all.

Oh I agree, people should be treated as people first.

The only real issue are likely surrounding your hormones and other prescribed meds such as spironolactone and how they might change your treatment.

Whether trained in a medical field or not, we all must be informed consumers of medical goods and services. And consumers is exactly what we are. I try to have a basic understanding of any condition that I've been diagnosed with, and knowledge about all meds I've been prescribed.

The one thing I have no tolerance for is what I call one size fits all medicine. I'll stop there before I run my BP up venting.

I take testosterone, but I don't really identify as male or female. I'm very happy with my body and vagina. I personally feel that if I can help medical professionals understand/see people like me, more dialogue can open up (as well as getting rid of some discomfort)

I am currently in hospital . 4th year medical students comes in with doctor on round. Sometimes they come in during day time and ask how am I doing , and sometimes they draw my blood under nurses supervision!

During my two intercoastal shots they were not allowed! It was a big NO if they could assist during my kidney biopsy!

And a more BIG no during NG tubes.

They are only allowed if they wanna draw blood and ask questions or few less painful shots or auscultation!

~cookie

During my years as a drug rep., I sold many gastro. products and my company wanted me to watch an upper and lower GI endoscopies. I set it up with a Gastro. Dr. and with patient permission watched about 50 colonoscopies and 25 upper endoscopies. I have also watched several general and orthopedic surgeries without patient permission, cause they were asleep and not nude. I was never allowed to get near any GYN patient, or any female with a condition that required her to be nude from the breasts down.

When I sold compression hose, I would carefully measure leg diameter every inch down the leg, in order to have custom made hosiery made. Most patients were females in their 40's-60's, with bad diabetes and vascular problems.

Personally, I have no problem with any Med. Student, or student nurse examining me; that's how they learn. Better yet, being a Med Fet person, I welcome it, as long as a qualified practitioner is there to stop screw ups.

One year I was at a national sales meeting for my drug company, when one of our V.P.'s told the crowd about the time in college when he was paid to be a "patient" at a teaching hospital. He said he got many enemas that summer, but it kept him in beer money! Huge crowd laughs!