As a nursing student, I always enjoyed being able to see first-hand new procedures, treatments, wounds and wound care on patients. Many of the patients were older and all were in the nursing homes we did our clinical rotations in. It wouldn’t be unusual for several of us to be gathered around a patient while the wound care nurse or doctor cleaned, debrided and dressed a pressure ulcer, and for us students, the opportunity to watch and help was always met with excitement.
But most of the time, the patient is given little thought, as though he or she is no more than a body part to show other doctors, nurses and students. Though many of the patients are admittedly demented, I sometimes wonder if we can’t do a better job of retaining their humanity in the process. Thinking about my own experience, I tried to always keep in mind that there was a living, breathing person attached to whatever body part we were examining.
Years ago, I was in a particularly volatile relationship. I was cut off from friends and family and convinced they wouldn’t help me. I had no access to my phone (and if any male friends called, I would have bruises later to show for it), nor did I have access to my car or money. He regularly beat me, forced me to do things with others, and slept around and bragged about it. When he hit me in public, people would look away, rather than try to intervene or help. When I finally did get the courage to leave (which amounted to me taking back streets and a taxi in the middle of the night with nothing more than my purse and what I was wearing), I went to the police and was the (female) officer told me she didn’t believe me.
All that aside, I had to go to the ED because he gave me herpes (the primary outbreak tends to be pretty terrible, and I didn’t have a doctor and wasn’t in a position to find one and wait for an appointment). Condoms were not exactly an option because I had very little say in anything, and often had no say in whether or not we had sex in the first place.
So there I was, 18-years-old and humiliated, ashamed, and thinking this is the end of my life, and that no one will ever love me or want me ever again, while the doctor is doing a pelvic exam and giving me the diagnosis I already knew.
But here’s where my point comes in: while the doctor is examining me, I show him my finger, which I thought was infected from a cut. He looks at it, then brings another younger doctor (or student) in, and shows it to her, explaining that it was actually herpetic whitlow. I’m lying on the exam table, still undressed with my legs in stirrups from the pelvic exam, crying and ashamed of the diagnosis and everything that led up to it, and this doctor decided that it was a perfect time to use me as a teaching example.
I understand the importance of doctors and medical students being able to see first-hand new or rare procedures, exams or illnesses, but don’t dehumanize your (awake, alert and oriented and obviously uncomfortable) patient in order to do so. In my case, I probably wouldn’t have minded the doctor bringing others in if he had simply asked my permission first. Had he explained what was wrong and why he wanted to show others, and allowed me to sit up and put my clothes back on first, I most likely would have gladly let him bring in whomever he wanted.
In our excitement to teach and learn, we must be careful not to forget that our patients are human.
“Alissa” is a nursing student.