Tuesday, November 06, 2007

Ethics of Medical Training Vol. 1

You're a patient at your local university hospital. Chances are good whatever is wrong with you is complex enough that you have traveled further than most people do when they go to the doctor. But then again, maybe you live just down the street! In any case, you come to the UXMC for the reputation, for the expertise, and to get an answer for what is wrong. It's your first visit. You've filled in the forms, the nurse has taken your vitals, and you're sitting in the cold, fluorescent bulb-lit exam room waiting to be seen, and who is the first to walk in? A twenty-something wearing a poorly-fit white coat grasping a clipboard like a security blanket. "Who is this?" you wonder, and "why does he look so nervous?"

Congratulations. You have just experienced a critical component of the graduate medical education complex. Shifting uncomfortably in front of you is the first rung of the ladder known as the medical hierarchy. Immediately you think, "How is this spring chicken going to heal me when all of the other docs were puzzled?" The answer is a little complex.

Hopefully the medical student in front of you is a little more comfortable than the way I've described him. Unless it's the month of July (when all of the residents and medical students are new), the student has already interacted with hundreds of patients, so he shouldn't have problems conducting an interview. At the foundation of your observation is a critical tension at the base of medical education and professional ethics: How are we to balance what is in the best interest of the patient with what is in the best interest of society? A byline of this tension is the medical student's concern about evaluation. While we students should be focusing on doing the right thing for the patient, many of us also want to do the right thing for our grades. That usually means thinking inside the box and being conservative with answers. Such thinking is not, however what doctors usually order at tertiary medical centers, and it's not what you need to solve your problem.

Fortunately, the medical hierarchy comes to the rescue. The residents, fellows and attending physicians who are actually liable for patient care benefit from the constant discussion, questioning and brainstorming (all lumped into that unfortunate term, 'pimping') that a teaching environment affords. You benefit from the system that brings you the medical student.

On a lighter note, keep in mind that medical students usually only take care of 2-3 patients at a time in the hospital. This means that they have more time to sit in your room and ask questions, catch overlooked relevant physical exam findings and pore over books (paper or electronic) to learn about your condition. And if you are a kid, maybe the student will take you over to the playroom to use the finger paints!

In many ways, you are the best teacher for medical students (especially those tired of sitting in class). Thanks for working with the medical student. Society thanks you, too.

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