Today I had a wonderful experience working with a group of anesthesiologists in the Operating Room preparing patients for surgery. Although I spent a fair amount of time waiting for the anesthesiologists and surgeons to arrive, I had the opportunity to bag and ventilate a patient, perform an intubation, and insert an intravenous catheter.
One interesting notion came up when I was talking to one of the anesthesiologists after I intubated a patient. He mentioned to me that he was bothered by something: that another physician asked him, in front of his patient and his patient’s family, whether it would be ok if this first year medical student (pointing to me) could help intubate the patient. While an appropriate question to ask, the anesthesiologist felt that it would have been better for the other physician to ask him the question out of the range of hearing of the patient and the patient’s family. Instead, the open question could have made the patient and the patient’s family members very uncomfortable or excessively worried. Should they be letting this medical student intubate their family member? Is this medical student properly trained in intubation? What if something bad happens?
In his opinion, these are reasonable concerns. However, if one has those considerations, then one should explicitly state these concerns at the beginning of the patient-doctor interaction. One might think, “Doctor, I’m here to see you, and I only want you to treat me.” On the other hand, this hospital is a teaching hospital, and there is an implicit disclosure in the name of the hospital as a medical training facility that there will be students and residents assisting with the procedures and learning the techniques. Furthermore, if patients and their families are concerned about having students assist in their treatments, why not complain about the trainee scrub techs (who assist at the surgical table), nurses, and circulators (who retrieve supplies in demand in the OR)? These trainees can just as easily make mistakes that may cost the lives of the patients, or at least substantially influence their health outcomes. Why, then, are some people so hard on medical students?
Taking that extra step of further exposing patients and their families to the reality of training physicians and their participation in treatments almost seems to suggest that they should be worried about an increased risk of negative outcomes, even if they weren’t worried before. Should they be? While there are some medical students who are cocky and overconfident, my impression is that most are relatively humble and underappreciative of their own abilities and skills as related to medicine. This is understandable since it seems like we have such a long way to go before we are “real doctors,” and we might expect some rite of passage to psychologically change our self perceptions. However, taking this morning’s example alone: I successfully performed the ventilation, intubation, and IV placement. This is not to say that I didn’t have any difficulty (I did have difficulty), but I succeeded without too much difficulty because I frequently consulted the physicians for advice and correction of my technique. At the end of the day, I acquired many important pointers and gained new first-time experiences, at no expense or discomfort to the patient. The physicians would not have let me do these procedures if they believed they would be too difficult for a student at my level. If the physicians are confident in the ability of trainees, why not patients and their families?
I’m inclined to agree with the anesthesiologist: why bother the patients and families with information that won’t provide them with beneficial knowledge? How much is too much information? Although medicine is moving away from a paternalistic stance to an approach emphasizing patient autonomy and informed consent, there still seems to be the possibility of overkill and of overtreating the problem.
As a closing note, it’s important for physicians, residents, and students to be sensitive and aware of how patients and their families feel: not all discussions and decisions need to be made with them as witnesses, especially those for which they are not offered roles as participants in the decision-making process. The needs of patients for maximizing positive health outcomes and the need of the field of medicine for experiential training of physicians do not need to be achieved at the expense of the other.
Advice to fellow medical students: As suggested by the anesthesiologist, don’t go up to the physician in front of the patient and the patient’s family and say with unbridled enthusiasm, “Doctor (insert name here), I’m (insert name here), a (number-year) medical student. Can I (insert procedure here) this patient?” Be professional and make requests under the right circumstances, not when they might make the patient and patient’s family uncomfortable or excessively worried.