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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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53. Student Patient Care
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The young medical practitioner starts life with 20 drugs for each disease, and the old medical practitioner ends life with one drug for 20 diseases.
~ William Osler
Identity Confusion
Navigating the Complexities of Student Patient Care
It was a busy day in the hospital, and Dr. Smith had a full schedule of patient appointments. As she walked into one of the exam rooms, she introduced herself to the patient and then turned to introduce her medical student, John, who was in his third year of training. However, she made a mistake and introduced him as “Dr. John,” without clarifying that he was a medical student.
The patient, an elderly woman, seemed to be confused and surprised to see such a young-looking doctor. Dr. Smith quickly realized her mistake and apologized for the confusion, but it was too late. The patient had already become suspicious and reluctant to cooperate.
John felt uncomfortable with the situation, but he remained silent, thinking that Dr. Smith was in charge and knew what she was doing. However, he knew that he was not supposed to make any medical decisions or write orders, as he was not yet licensed to practice medicine.
As they began the exam, John tried to help Dr. Smith by asking some basic medical questions. However, the patient interrupted him, saying, “I thought you were a doctor. Are you a student?” John then explained that he was a medical student and that he was there to learn from Dr. Smith. The patient seemed satisfied with the explanation and agreed to continue with the exam.
After they finished the exam, Dr. Smith reviewed the patient’s chart and made some notes. John watched her carefully, trying to learn as much as possible. However, he noticed that Dr. Smith seemed to be in a hurry and did not spend much time with the patient.
As they left the room, John asked Dr. Smith if he could review the patient’s chart and follow up with her later. Dr. Smith agreed but warned him to be careful not to cross the line of practicing medicine without a license. John nodded and promised to be careful.
Later that day, John reviewed the patient’s chart and realized that Dr. Smith had missed some critical details. He decided to call the patient to follow up and ask some additional questions. However, when he called, the patient refused to talk to him, saying that she did not trust him or Dr. Smith.
John felt guilty and ashamed. He knew that he had violated the patient’s trust and that he had not followed the proper procedures for student patient care. He decided to talk to Dr. Smith and explain what had happened. She listened to him carefully and then apologized for her mistake. She also promised to talk to the patient and try to regain her trust.
The next day, Dr. Smith and John went to see the patient together. They explained what had happened and apologized for the confusion. They also reassured her that John was a medical student who was there to learn from Dr. Smith, and that he would not make any medical decisions or write orders without her consent.
The patient seemed to be relieved and thanked them for their honesty. She agreed to continue with her treatment and even allowed John to ask some additional questions. John was grateful for the opportunity to learn and apologized again for his mistake.
From that day on, John was more careful when introducing himself to patients and always made sure to clarify that he was a medical student. He also realized the importance of the patient-practitioner relationship and the need for full disclosure and informed consent in student patient care. Dr. Smith became his mentor and taught him many valuable lessons about the art of medicine, including the importance of patient-centered care, ethical principles, and professional responsibility.
Abstract
The obligation of medical practitioners to teach, mentor, and induct medical students into the art of medicine is a professional and moral responsibility. The patient-practitioner relationship is critical in good patient care, and medical students’ involvement must only occur with full disclosure and the patient’s informed consent. Patient autonomy and practitioner’s obligation to beneficently provide care (do good) and avoid harm (nonmaleficence) must always be respected. Unlicensed medical students must not make independent medical judgments, prescribe drugs, or write orders and must not be misrepresented when being introduced to the patient. The medical student must always be under the supervision of the attending practitioner and must not cross the line of practicing medicine without a license. Medical students must respect the public trust and the privilege of being in the medical profession.
**
Think
[53:1] Medical practitioners have a professional and moral obligation to teach, mentor, and induct medical students into the art of medicine. The practitioner’s title of Doctor comes from Latin docere, which means to teach. Practitioners are obligated to teach their patients their diagnosis, prognosis, and treatment options, and they are obliged to teach and mentor the next generation of practitioners with the knowledge and skills necessary for good patient care.
[53:2] Good patient care is dependent upon the patient-practitioner relationship. This means that teaching the art of medicine to medical students can only occur within the context of the patient-practitioner relationship. Therefore, it must be clear to the patient who the medical student is, what year in the program they are in, their level of expertise, and who is supervising them. Any medical student status obfuscation violates the patient-practitioner relationship and violates legal, professional, and ethical mandates. The patient’s willingness to participate in the education of medical students is imperative and can only occur within the patient-practitioner relationship.
Assess
Patient: 1) Autonomy
[53:3] Central to all medicine is the history and physical, which can only occur within the patient-practitioner relationship in which the patient trusts that the practitioner will keep all protected health information (PHI) confidential and private. Most patients are more than willing to help aspiring medical students and residents learn the art of medicine so that they can become licensed practitioners.
[53:4] The patient must understand and trust that any patient engagements will only occur after full disclosure and the patient has given informed consent for allowing each engagement. This is especially true for medical student involvement when the patient is temporarily incapacitated.
[53:5] Active patient participation starts with the patient providing informed consent giving the medical student or resident the authority to conduct a patient history and physical (H&P) under the supervision of the attending practitioner. However, the attending practitioner must personally review the patient’s history and physical (H&P) and not just cosign the work of a medical student who is not a licensed practitioner.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[53:6] Professionally, practitioners ensure that the patient knows that not all ‘doctors’ are licensed physicians who can practice medicine without supervision. Without specific clarification, it is never professionally, legally, or ethically permissible to introduce a non-licensed physician as “Doctor” to a patient, as that is fraud. Even if a student has a PhD, MD, Doctorate in Pharmacology, or any number of other doctorate degrees, but is not a licensed physician, and if the term “doctor” is used when introducing the medical student or resident to the patient, then the introduction must be accompanied with a clarification that the student or resident is not a licensed practitioner and is under the supervision of the attending practitioner.
[53:7] A practitioner’s professional obligation is to provide patient-centered care in which the patient’s best interests are maximized in accordance with the patient’s reasonable goals, values, and priorities. This is accomplished by practitioners only providing medical standards of care recognized by the medical profession as beneficent (good) and nonmaleficent (no harm) to the patient.
[53:8] Professionally, legally, and ethically, it is impermissible for any medical student or resident to practice unsupervised medicine without being a licensed practitioner. Therefore, the attending practitioner must exercise due diligence to supervise all medical student and resident patient interactions. If a medical student makes a medical judgment or acts independently of medical supervision, then the student is practicing medicine without a license. If true, then the medical student and the attending practitioner can be held liable for any patient injuries. Practicing medicine without a license is a form of medical quackery and medical misconduct.
Public Policy: 4) Justice
[53:9] Both the public at large and patients generally give high regard toward medical students. Students should embrace and own the limited amount of time they have to enjoy the privilege of being a medical student who wears the short white coat. Society, institutions, profession, and patients all know the importance of medical students being mentored into the medical profession, and as a result, a significant amount of respect and honor is conferred to the student.
[53:10] That being said, under no condition is it ever permissible for an unlicensed medical student to independently write an order, prescribe and dispense drugs, or make independent medical judgments. In a medical emergency, staff and other interprofessionals need to follow established medical protocols and the attending practitioner’s orders, but never a medical student’s advice or medical judgment.
[53:11] All medically licensed nurses and other health care practitioners have more legal authority, responsibility, and accountability than a medical student, no matter how much experience the student has and how close the student is to becoming a licensed practitioner. Under the law, someone is either licensed or not licensed; there is no in-between. It behooves the medical student to take advantage of the opportunity to learn and serve, but also to be careful never to cross the line of making medical judgments that could result in the unaccepted practice or even perception of practicing medicine without a license.
Conclude
[53:12] Medical students and unlicensed practitioners must not be misrepresented when being introduced to the patient, and the patient must provide informed consent authorization for each procedure conducted by a student. It is imperative that the medical student does not practice medicine without a license and that all student patient interactions are under the supervision of the attending practitioner.
[53:13] In summary, medical practitioners have a professional and moral obligation to teach, mentor, and induct medical students into the art of medicine, but the involvement of students in patient care must be with full disclosure and the patient’s informed consent. Medical students must always be under the supervision of the attending practitioner, and they must not make independent medical judgments, prescribe drugs, or write orders. The attending practitioner must exercise due diligence to supervise all medical student and resident patient interactions, and medical students must not practice medicine without a license. All medically licensed nurses and other interprofessionals have more legal authority, responsibility, and accountability than a medical student, no matter how much experience the student has and how close the student is to becoming a licensed practitioner.
**
53. Review Questions
1. The practitioner’s title of Doctor comes from Latin docere, which means to practice medicine.
2. It must be clear to the patient who the medical student is, what year in the program they are in, level of expertise, and who is supervising.
3. Without specific clarification, it is never professionally, legally, or ethically permissible to introduce a non-licensed practitioner as “Doctor” to a patient as that is fraud.
4. If a medical student makes a medical judgment or acts independently of medical supervision, then the student is practicing medicine without a license.
5. In a medical emergency, staff and other health care practitioners need to follow established protocols and the attending’s orders, but never the advice or medical judgment of a medical student.
6. The medical student should take advantage of the opportunity to learn and serve, but also be careful never to cross the line of making medical judgments that could result in the unaccepted practice or even perception of practicing medicine without a license.
**
CORRECT! 🙂
[53:1] Medical practitioners have a professional and moral obligation to teach, mentor, and induct medical students into the art of medicine. The practitioner’s title of Doctor comes from Latin docere, which means to teach. Practitioners are obligated to teach their patients their diagnosis, prognosis, and treatment options, and they are obliged to teach and mentor the next generation of practitioners with the knowledge and skills necessary for good patient care.
Wrong 😕
[53:1] Medical practitioners have a professional and moral obligation to teach, mentor, and induct medical students into the art of medicine. The practitioner’s title of Doctor comes from Latin docere, which means to teach. Practitioners are obligated to teach their patients their diagnosis, prognosis, and treatment options, and they are obliged to teach and mentor the next generation of practitioners with the knowledge and skills necessary for good patient care.
Wrong 😕
[53:2] Good patient care is dependent upon the patient-practitioner relationship. This means that teaching the art of medicine to medical students can only occur within the context of the patient-practitioner relationship. Therefore, it must be clear to the patient who the medical student is, what year in the program they are in, their level of expertise, and who is supervising them. Any medical student status obfuscation violates the patient-practitioner relationship and violates legal, professional, and ethical mandates. The patient’s willingness to participate in the education of medical students is imperative and can only occur within the patient-practitioner relationship.
CORRECT! 🙂
[53:2] Good patient care is dependent upon the patient-practitioner relationship. This means that teaching the art of medicine to medical students can only occur within the context of the patient-practitioner relationship. Therefore, it must be clear to the patient who the medical student is, what year in the program they are in, their level of expertise, and who is supervising them. Any medical student status obfuscation violates the patient-practitioner relationship and violates legal, professional, and ethical mandates. The patient’s willingness to participate in the education of medical students is imperative and can only occur within the patient-practitioner relationship.
CORRECT! 🙂
[53:6] Professionally, practitioners ensure that the patient knows that not all doctors are licensed physicians who can practice medicine without supervision. Without specific clarification, it is never professionally, legally, or ethically permissible to introduce a non-licensed physician as “Doctor” to a patient as that is fraud. If a student has a PhD, MD, Doctorate in Pharmacology, or any number of other doctorate degrees, but is not a licensed physician, and if the term “doctor” is used when introducing the medical student or resident to the patient, then the introduction must be accompanied with a clarification that the student or resident is not a licensed practitioner and is under the supervision of the attending practitioner.
Wrong 😕
[53:6] Professionally, practitioners ensure that the patient knows that not all doctors are licensed physicians who can practice medicine without supervision. Without specific clarification, it is never professionally, legally, or ethically permissible to introduce a non-licensed physician as “Doctor” to a patient as that is fraud. If a student has a PhD, MD, Doctorate in Pharmacology, or any number of other doctorate degrees, but is not a licensed physician, and if the term “doctor” is used when introducing the medical student or resident to the patient, then the introduction must be accompanied with a clarification that the student or resident is not a licensed practitioner and is under the supervision of the attending practitioner.
CORRECT! 🙂
[53:8] Professionally, legally, and ethically, it is impermissible for any medical student or resident to practice unsupervised medicine without being a licensed practitioner. Therefore, the attending practitioner must exercise due diligence to supervise all medical student and resident patient interactions. If a medical student makes a medical judgment or acts independently of medical supervision, then the student is practicing medicine without a license. If true, then the medical student and the attending practitioner can be held liable for any patient injuries. Practicing medicine without a license is a form of medical quackery and medical misconduct.
Wrong 😕
[53:8] Professionally, legally, and ethically, it is impermissible for any medical student or resident to practice unsupervised medicine without being a licensed practitioner. Therefore, the attending practitioner must exercise due diligence to supervise all medical student and resident patient interactions. If a medical student makes a medical judgment or acts independently of medical supervision, then the student is practicing medicine without a license. If true, then the medical student and the attending practitioner can be held liable for any patient injuries. Practicing medicine without a license is a form of medical quackery and medical misconduct.
CORRECT! 🙂
[53:10] That being said, under no condition is it ever permissible for an unlicensed medical student to independently write an order, prescribe and dispense drugs, or make independent medical judgments. In a medical emergency, staff and other interprofessionals need to follow established medical protocols and the attending practitioner’s orders, but never a medical student’s advice or medical judgment.
Wrong 😕
[53:10] That being said, under no condition is it ever permissible for an unlicensed medical student to independently write an order, prescribe and dispense drugs, or make independent medical judgments. In a medical emergency, staff and other interprofessionals need to follow established medical protocols and the attending practitioner’s orders, but never a medical student’s advice or medical judgment.
CORRECT! 🙂
[53:11] All medically licensed nurses and other interprofessionals have more legal authority, responsibility, and accountability than a medical student, no matter how much experience the student has and how close the student is to becoming a licensed practitioner. Under the law, someone is either licensed or not licensed; there is no in-between. It behooves the medical student to take advantage of the opportunity to learn and serve, but also to be careful never to cross the line of making medical judgments that could result in the unacceptable practice or even perception of practicing medicine without a license.
Wrong 😕
[53:11] All medically licensed nurses and other interprofessionals have more legal authority, responsibility, and accountability than a medical student, no matter how much experience the student has and how close the student is to becoming a licensed practitioner. Under the law, someone is either licensed or not licensed; there is no in-between. It behooves the medical student to take advantage of the opportunity to learn and serve, but also to be careful never to cross the line of making medical judgments that could result in the unacceptable practice or even perception of practicing medicine without a license.
53. Clinical Vignettes
1. Mr. Timothy Nguyen is a 57-year-old retired engineer who presents to the clinic with a six-month history of intermittent epigastric pain, bloating, and weight loss. He reports that the pain is usually relieved with antacids, but it recurs every few days. He denies any vomiting, hematemesis, or melena. His medical history is significant for hypertension and hyperlipidemia. A clinical differential diagnosis of gastroesophageal reflux disease, peptic ulcer disease, and gastric cancer is considered. A medical student is assigned to accompany the attending practitioner during the patient’s visit. The attending practitioner introduces the medical student as Dr. David Kim. The medical student proceeds to take a history and physical examination (H&P) under the supervision of the attending practitioner.
2. Mr. Joseph Campbell is a 45-year-old accountant who presents to the clinic with a two-week history of cough, shortness of breath, and fever. He reports that the symptoms started as a mild cough but have progressed to become more severe. He denies any chest pain or palpitations. His medical history is significant for asthma. A clinical differential diagnosis of pneumonia, bronchitis, and acute exacerbation of asthma is considered. A medical student is assigned to accompany the attending practitioner during the patient's visit. The attending practitioner introduces the medical student as a second-year medical student, and the medical student proceeds to take a history and physical examination (H&P) under the supervision of the attending practitioner.
3. Ms. Gabriella Brown is a 25-year-old teacher who presents to the emergency department with a sudden onset of severe chest pain and shortness of breath. She reports that the pain started while she was sitting at her desk and has been constant since then. She denies any history of heart disease or similar episodes. A clinical differential diagnosis of acute coronary syndrome, pulmonary embolism, and aortic dissection is considered. A medical student is assigned to assist the attending practitioner in the evaluation of the patient. The attending practitioner introduces the medical student as a third-year medical student, and the medical student proceeds to take a focused history and physical examination under the direct supervision of the attending practitioner. During the examination, the medical student observes that the patient is pale, diaphoretic, and in severe distress. The student suggests that the patient be given oxygen and started on anticoagulation therapy immediately. The attending practitioner reminds the medical student that in a medical emergency, staff and other health care practitioners need to follow established protocols and the attending's orders, but never the advice or medical judgment of a medical student [53:10]. The attending practitioner then proceeds to give orders for supplemental oxygen and a diagnostic workup, including an electrocardiogram and a chest X-ray.
4. Mr. John Wilson is a 42-year-old truck driver who presents to the urgent care clinic with a one-day history of severe abdominal pain and diarrhea. He reports that the pain is located in the left lower quadrant and is associated with bloating and nausea. He also reports passing watery stools with mucus and blood. His medical history is significant for hypertension and obesity. A clinical differential diagnosis of diverticulitis, inflammatory bowel disease, and infectious colitis is considered. A medical student is assigned to assist the attending practitioner in the patient's evaluation. The attending practitioner introduces the medical student as a third-year medical student, and the medical student proceeds to take a focused history and physical examination under the direct supervision of the attending practitioner. During the evaluation, the medical student suggests obtaining a stool sample for microbiological analysis to identify the possible infectious agent causing the patient's diarrhea. The attending practitioner agrees with the medical student's suggestion and orders the test. The results come back positive for Escherichia coli O157:H7, a type of bacteria known to cause foodborne illness.
5. Mr. Dylan Bailey is a 40-year-old accountant who presents to the clinic with a two-day history of dyspnea, cough, and fatigue. He reports that the cough is productive of yellowish sputum and that he has experienced chills and fever. He denies any chest pain, palpitations, or syncope. His medical history is significant for hypertension and diabetes mellitus. A clinical differential diagnosis of community-acquired pneumonia, bronchitis, and asthma is considered. A medical student is assigned to assist the attending practitioner in the patient's evaluation. The attending practitioner introduces the medical student as a fourth-year medical student and leaves the clinic to attend to an emergency in the hospital.The medical student proceeds to take a history and physical examination, order a chest x-ray, and prescribe antibiotics for community-acquired pneumonia without consulting the attending practitioner. The patient returns to the clinic two days later with worsening symptoms, and a repeat chest x-ray shows no improvement in the pneumonia. The attending practitioner becomes aware of the situation and re-evaluates the patient, orders additional tests, and changes the antibiotics.
CORRECT! 🙂
Explanation: The introduction of the medical student as “Dr. David Kim” violates the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:6]. Introducing a non-licensed physician as “Dr.” to the patient is a form of fraud and misrepresentation. It is ethically, legally, and professionally impermissible [53:6]. The correct ethical approach is to introduce the medical student as a medical student, clearly stating the student's level of expertise, the year in the program, and that the student is not a licensed practitioner. The patient must also provide informed consent for each student interaction, and the attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The other options are incorrect as the introduction of the medical student as “Dr. David Kim” is fraud, the medical student did not practice unsupervised medicine, the student was given the opportunity to learn and serve under the attending practitioners supervision, and none of them addressed the main ethical issue of misrepresentation and deception.
Wrong 😕
Explanation: The introduction of the medical student as “Dr. David Kim” violates the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:6]. Introducing a non-licensed physician as “Dr.” to the patient is a form of fraud and misrepresentation. It is ethically, legally, and professionally impermissible [53:6]. The correct ethical approach is to introduce the medical student as a medical student, clearly stating the student's level of expertise, the year in the program, and that the student is not a licensed practitioner. The patient must also provide informed consent for each student interaction, and the attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The other options are incorrect as the introduction of the medical student as “Dr. David Kim” is fraud, the medical student did not practice unsupervised medicine, the student was given the opportunity to learn and serve under the attending practitioners supervision, and none of them addressed the main ethical issue of misrepresentation and deception.
CORRECT! 🙂
Explanation: This scenario upholds the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:5]. The patient has been informed of the medical student's status, and the medical student is under the supervision of the attending practitioner. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction [53:5]. The other options are incorrect because the patient was informed of the medical student's status, the medical student did not prescribe medication without the attending practitioner's review, and the medical student was given the opportunity to learn and serve under the attending practitioner's supervision.
Wrong 😕
Explanation: This scenario upholds the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:5]. The patient has been informed of the medical student's status, and the medical student is under the supervision of the attending practitioner. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction [53:5]. The other options are incorrect because the patient was informed of the medical student's status, the medical student did not prescribe medication without the attending practitioner's review, and the medical student was given the opportunity to learn and serve under the attending practitioner's supervision.
CORRECT! 🙂
Explanation: This scenario upholds the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:10]. The medical student is under the direct supervision of the attending practitioner, and the attending's orders are followed in a medical emergency. In a medical emergency, staff and other health care practitioners need to follow established protocols and the attending's orders, but never the advice or medical judgment of a medical student [53:10]. The correct ethical approach is to prioritize the patient's well-being and follow the established protocols and orders in a medical emergency. The other options are incorrect because the medical student is under the direct supervision of the attending practitioner, the patient is not informed of the medical student's status, the medical student is not given the opportunity to learn and serve under the attending practitioner's supervision, and the medical student is not allowed to prescribe medication without the attending practitioner's review.
Wrong 😕
Explanation: This scenario upholds the ethical principles of patient autonomy, beneficence, and nonmaleficence [53:10]. The medical student is under the direct supervision of the attending practitioner, and the attending's orders are followed in a medical emergency. In a medical emergency, staff and other health care practitioners need to follow established protocols and the attending's orders, but never the advice or medical judgment of a medical student [53:10]. The correct ethical approach is to prioritize the patient's well-being and follow the established protocols and orders in a medical emergency. The other options are incorrect because the medical student is under the direct supervision of the attending practitioner, the patient is not informed of the medical student's status, the medical student is not given the opportunity to learn and serve under the attending practitioner's supervision, and the medical student is not allowed to prescribe medication without the attending practitioner's review.
Wrong 😕
Explanation: This scenario upholds the ethical principle of nonmaleficence as the attending practitioner and the medical student work together to identify the possible infectious agent causing the patient's diarrhea and provide appropriate treatment [53:10]. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction [53:5]. The other options are incorrect because the attending practitioner and the medical student work together to provide appropriate care, the patient's autonomy is not violated as they are informed of the medical student's involvement in the evaluation, the medical student is learning and serving under the attending practitioner's supervision, and the medical student is not allowed to perform unsupervised medical decision-making.
CORRECT! 🙂
Explanation: This scenario upholds the ethical principle of nonmaleficence as the attending practitioner and the medical student work together to identify the possible infectious agent causing the patient's diarrhea and provide appropriate treatment [53:10]. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction [53:5]. The other options are incorrect because the attending practitioner and the medical student work together to provide appropriate care, the patient's autonomy is not violated as they are informed of the medical student's involvement in the evaluation, the medical student is learning and serving under the attending practitioner's supervision, and the medical student is not allowed to perform unsupervised medical decision-making.
CORRECT! 🙂
Explanation: This scenario violates the ethical principle of nonmaleficence as the medical student's unsupervised decision-making led to harm to the patient [53:8]. According to medical student Standard Operating Procedures (SOP), medical students must not make independent medical judgments or act independently of medical supervision [53:8]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The other options are incorrect because the patient's autonomy was not violated, the medical student did not have the opportunity to learn and serve under the attending practitioner's supervision, and the medical student was allowed to perform unsupervised medical decision-making.
Wrong 😕
Explanation: This scenario violates the ethical principle of nonmaleficence as the medical student's unsupervised decision-making led to harm to the patient [53:8]. According to medical student Standard Operating Procedures (SOP), medical students must not make independent medical judgments or act independently of medical supervision [53:8]. The correct ethical approach is to introduce the medical student as a medical student, not as a licensed practitioner, and to obtain the patient's informed consent for each student interaction. The attending practitioner must exercise due diligence to supervise all student patient interactions [53:5]. The other options are incorrect because the patient's autonomy was not violated, the medical student did not have the opportunity to learn and serve under the attending practitioner's supervision, and the medical student was allowed to perform unsupervised medical decision-making.
**
53. Reflection Vignettes
1. Dr. Emily Wilson, a 32-year-old attending physician, is supervising a medical student at her clinic. The student, John Doe, has recently graduated from medical school but has not yet passed Step 3 of the medical licensing exam and is not yet licensed to practice independently. Under Dr. Wilson's supervision, John is asked to introduce himself to a patient who has come in for a routine check-up. The patient, a 55-year-old man with a history of hypertension, is initially hesitant to speak with John but ultimately agrees. Dr. Wilson remains present during the conversation and ensures that John's interactions with the patient are appropriate and professional. The differential diagnosis includes routine check-up, hypertension management, and medication reconciliation.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Ms. Sarah Johnson, a 25-year-old woman, is a medical student in an obstetrician-gynecologist rotation. The attending practitioner instructs her to perform a pelvic examination on an unconscious, sedated patient who is undergoing a surgical procedure. The attending practitioner tells her that the patient will be relaxed and that it would be an excellent opportunity for her to practice. When Ms. Johnson raises concerns about obtaining the patient's informed consent for the examination, the attending tells her that the patient's general consent to receive treatment at a teaching hospital covers the student's practice. The differential diagnosis for this situation is that it is an unethical violation of the patient's right to informed consent and privacy.
The scenario described is unethical because it violates the patient's autonomy and informed consent. Patients have the right to be informed about all aspects of their medical care, including who will be performing procedures on them, and to give explicit consent for each procedure. In this case, the patient was unconscious and therefore unable to give informed consent for a medical student to perform a pelvic examination. Furthermore, the attending practitioner's claim that the patient's general consent for treatment at a teaching hospital covers the student's practice of a pelvic exam is not valid, as general consent does not imply consent for every possible procedure that may be performed by a medical student. Additionally, performing a procedure on an unconscious patient without their explicit consent violates the principle of nonmaleficence, as it can cause harm and discomfort to the patient without their knowledge or agreement. Overall, this scenario represents a clear violation of medical ethics and professional conduct.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
