When it comes to medical residents, patients have a choice

A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything.  An MD is just a piece of paper saying you did your time in the lecture hall/lab.  Residency is where you learn how to be a doctor.  The term “resident” originates from the old days in which newly-minted doctors were actually living at hospitals in designated housing and caring for patients essentially 24/7.

That doesn’t happen anymore but residents still work the equivalent of 2 full-time jobs and do all of the basic grunt work that actually helps you get better.  If you go to an academic medical center for your care, you will be seen at some point by a resident.  That is a large part of what academic centers do.  They teach new doctors how to be doctors.  Medicine is really learned more on an apprentice model than anything else.

Residency can last anywhere from 3 to 10 years, depending on the specialty.  So a doctor training to be a surgeon will do maybe 4 years, plus maybe 2 years of research and then another year or so of specialized training in one area of surgery.  An anesthesiologist does 3 years, plus an optional fourth year of specialization.  Medical doctors do three years and then specialize with one or two more years.

So, if you see a resident, that person could be:

  • straight out of med school
  • have a year of experience
  • be three days away from finishing residency
  • really really really tired

If you want, you can ask them what year they are.  The less experience they have, the more supervision they will have: please don’t doubt this.  It might not look like it, but the newbies are getting the close eye from an attending somewhere.  The only way for them to learn is to do.

So you the patient have a choice: you can roll your eyes and look at the poor guy with distrust and demand a more senior person, or you can be patient and allow yourself to be a teacher.  Within reason of course – no one is asking you to let the first year do surgery on you.  But let them interview you, try an IV maybe.  When I gave birth to my kids I had people in various levels of training taking care of me.  I had a med student interview me, I had a student nurse put my IV in (she missed once, but no worries, she got it the second time).  I was happy to have a resident put my epidural in – I know they’ve done hundreds of them in the last week.  If you go to an academic medical center for your care, you will be seen at some point by a resident.

There was an article in the New York Times about a woman who used to be a nurse who was dying of cancer and, as a last act, called her alma mater and offered herself as a practice patient for nursing students trying to learn how to take care of dying people.  An extreme example maybe, but instructive of the role patients have to play in teaching doctors how to do their work in the best and most patient-centered way possible.

You absolutely have a choice.  You do not have to be cared for by a trainee.  If you don’t want residents, go to a community or private hospital. If you go to a teaching hospital, in a way it’s understood that your job is to help teach.  The attendings will make sure you are well cared for, and maybe you can help make a new doctor a better doctor.

Shirie Leng is an anesthesiologist who blogs at medicine for real.

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  • anon

    No mention of DO residents >.>

  • Alice Gray

    I’m sure I’m not the only resident insulted by the statement “not yet qualified to actually do anything”.
    While it’s true that we typically have the supervision of an attending
    physician, residents are qualified to perform many of the duties of an
    attending physician, particularly in the latter years of a training
    program. Residents of all levels in my program deliver babies, perform
    procedures, perform cesarean sections, hysterectomies, and many other
    types of surgery. I agree with the intent of this article to encourage
    open discussions with patients who may be weary of residents, however
    using that opening line (which is the only statement to appear on the lead page of the U.S. section)
    likely does just the opposite. Alice Gray, D.O.

  • Sathyadeepak Ramesh

    MD = DO…why mention it separately?

  • shiriegale

    Doug – thanks for your comments. Would love to read your book. You are absolutely right that patients are not the “property” of the hospital in any sense. In claiming that patients have a responsibility to teach I mean that it is the responsibility of all of us to teach the next generation. Full disclosure is the key.
    In reference to OB/Gyn specifically, as a medical student I was extremely disturbed by learning to do a pelvic exam on a woman in a room with 8 other students. The woman herself explained to me that she had volunteered to do this and felt it was important to contribute in this way. She was no doubt a very unusual person. I have had three children and have always been asked permission before anyone entered during my labors. When I have residents in my ORs I always insist that they introduced themselves to the patient and explain what they are doing there and how they will be involved in the case, if at all.
    No doctor should assume that any patient will consent to be treated by students and residents. On the other hand you couldn’t run a hospital if you had to ask every single person their preference. Patients need to be educated ahead of time if possible that if they go to X hospital, residents will be part of their care.

  • EmilyAnon

    I think what bothers me as a patient is the attitude found on this and other medical forums the sense of entitlement trainees have toward patients. Their bodies taken as eminent domain whether in the hospital or doctor’s office. Deception (false introductions) seems to be tolerated as justification to aid the trainees agenda. Dr. Atul Gawanda said that trainees are encouraged to “steal” their learning from the patient, through elision or behind OR drapes. But they also steal the patient’s dignity, often causing long lasting resentment and distrust between doctor and patient. And for the shy patient to fear denial of care (per many threats in the shadowing thread) if they don’t cooperate with a roomful of strangers witnessing a personal exam, is the ultimate in exploitation. There’s got to be a better way.

  • Suzi Q 38

    I don’t mind at all. I just like to know who is doing the procedure on me.
    I am 57, and the doctors at the teaching hospitals seem to get younger and younger. If a doctor is doing my lumbar puncture, I want to make sure that it will be done properly. I was especially nervous the first time.

    I asked the doctor if he was a resident or medical student.
    Embarrassing. He kind of lacked confidence. He was shy.

    I had taken aspirin the night before, due to clerical errors…no one called me to prep me for the procedure. I told him that I had taken 81 mg of aspirin every night like usual. I didn’t want the procedure done if it wasn’t safe.
    He said that the students are so careful and supervised that I need not worry about that.