They’re very easy to spot. Sometimes it’s the crisp, brand-new lab coat or the shadows under their eyes. Often it’s announced in large letters on their ID badge. Or the badge is hidden, which is also a tell. If they’re trying to avoid being spotted, they’ll usually say they’re “working with” my doctor, as though I can’t figure out what that means.
Well, hello, resident doctor.
I see a lot of you at my immunologist’s office, and by now, you’re part of the fabric of the clinic for me. I go over my case history with any resident who asks. I’ll let them examine me. I’ll answer questions. If they want to stand in the corner of the exam room and silently observe my conversation with my doctor, that’s fine too. I’ve been happy to participate in numerous research studies for primary immunodeficiency and heart issues, striving for the greater good for other patients.
On the other hand, if I’m in a procedure room and a resident appears, I’m unhappy.
Reluctance to be treated by residents is usually chalked up to ignorance, and institutional entitlement toward patients’ bodies runs deep. There’s the unrelenting expectation that brand-new doctors and students should always be able to examine or practice procedures on patients without true consent or alternative. Patients’ feelings on this issue are often ignored, even when they find it upsetting to be used as educational props, or there is zero benefit to their health. Several states have passed laws prohibiting nonconsensual intimate exams on patients under anesthesia because hospitals would not voluntarily stop this practice.
Yes, I understand every doctor has to learn. I also believe there are significant issues with how this currently occurs, and that it isn’t always positive for patients.
A common rejoinder is to tell patients to go somewhere else if they don’t want residents or students treating them, but is this realistic?
Insurance may not cover another hospital. Another hospital might not exist — many hospitals have merged or closed. There might be just one game in town. If you have an uncommon condition or require complex care, the only doctors who can actually treat you might be at teaching hospitals. You’re forced to choose between “allowing” your body to be used as a teaching tool — and that consent is dubious, given the lack of viable alternatives — and foregoing lifesaving care. And in my experience, every hospital is a teaching hospital now, as are outpatient facilities ranging from community clinics to VA facilities to doctor’s offices. There’s really no escape.
There are several specific reasons why I, as a patient, recoil when a resident walks into the room and announces they’re treating me, not just observing.
1. Sleep deprivation. We don’t want drowsy people driving or operating heavy machinery. We don’t think it’s safe for pilots to work 24 hours straight. We don’t even routinely expect it of established doctors: very long operations usually have several surgical teams that switch off. Yet it’s status quo for residents responsible for people’s lives to slog through marathon shifts. I was horrified to learn the Libby Zion Law in New York and 2003 national reforms limit residents to only 80 hours a week.
Residents themselves have stated that severe exhaustion negatively impacts decision-making and compassion for patients. So I don’t want a doctor in the 20th hour of their shift making key decisions about my care. That’s not a criticism of the residents themselves. It’s a strong condemnation of the system endangering both residents and patients.
2. Some of them aren’t paying attention. Years ago, I was bitten by a bat. When I sought medical help, I was seen by a condescending resident at a neighborhood clinic, who insisted bat bites didn’t require rabies post-exposure prophylaxis. If I hadn’t sought a second opinion, her ignorance could have killed me. Residents have suggested medication for me without cross-checking to discover it severely interacts with my other meds. When I was a passenger in a minor car accident, the ER resident wrote I’d been “hurt by a catheter.”
At the immunology clinic, I’ve encountered residents devoid of compassion and listening skills — possibly, collateral damage from exhaustion. One shrugged off the symptoms I was reporting with, “Well, we can bring this up, but it means nothing.” I calmly informed the resident I didn’t need her permission to discuss my own symptoms with my doctor. The symptoms actually turned out to be significant. When my mother was in the ICU after open heart surgery, several residents were impatient and downright hostile when she expressed emotional distress.
I shouldn’t have to worry that a resident might have a god complex or complete contempt for their patients.
3. Doctors are not interchangeable. When I book an appointment with a specific doctor, it’s because I want to see them, not a random person in scrubs. If that statement raises your hackles, gentle physician readers, I’d ask: are you and your peers unremarkable and interchangeable? I don’t think so, and neither should you. Your specific education, training and experience are all important factors that heavily influence outcomes, and that’s why patients want to see you.
As a patient, I need to trust my doctors. I can’t do that if they’re handing my care over to a resident I have never met and know nothing about.
If you’re a resident, what’s the appropriate response when a patient recoils? Sure, you can think your patients are ignorant clods. It’s better to remember they may have had negative past experiences with residents. It’s not about you personally. It’s about a person desperate to ensure as painless and uneventful a procedure or treatment as possible.
And in their quest to do no harm, medical facilities need to remember their patients are human beings — not teaching props. Patients’ participation in the educational process is not necessarily something that benefits them. They’re there to receive competent medical care, and that should not be compromised.
Denise Reich is a patient advocate.