Is physician shadowing immoral?


Countless times as a patient both at two hospitals in New York City, I have witnessed doctors arrogantly waltzing into an examination room and arriving not alone but with an entourage. Like Greeks bearing gifts, they arrived with something unwanted and threatening: medical students, interns, residents, and fellows. And not once, in all the many times that I have been subjected to this ignominious practice, was my consent ever obtained prior to the doctor’s arrival.

Some would argue that this practice is perfectly acceptable provided high school students and college students are not doing the shadowing. The idea that such young students could ever be permitted to shadow a doctor is utterly ludicrous. Even if a physician wished to have a resident or fellow observe a session with a patient, should they not in good conscience be morally, if not legally, obligated to first obtain the patient’s permission?

There are hundreds of teaching hospitals in this country that serve millions of patients. Are all of these patients supposed to voluntarily relinquish all vestiges of privacy?

If a patient is denied the right to meet with their doctor in private, what rights does the patient actually have? Do they have the right to discuss their medical questions and concerns with their doctor in confidentiality, and without unwanted interlopers in the room? Do they have the right to a respectful medical examination without unwanted persons in the room violating their privacy in a base and barbarous fashion?

There are physicians who argue that it would be impossible to train the younger generation of doctors should any restrictions be placed on this practice. Yet, those who make this argument fail to acknowledge the fact that, should patients be asked, many would, in fact, give their consent.

As a photographer, I feel that it is unethical to take the portrait of a stranger without first obtaining their consent. Does it follow that I am then making the case that photographic portraiture be banned altogether?

It is this absence of consent, which can bring about a profound degradation of trust — a trust not only in the patient’s physician — but in the entire medical profession. And the ramifications of this violated trust can be extremely grave.

Many of the most enthusiastic supporters of physician shadowing ardently defend the practice, just so long as they are not the patients and on the receiving end of it. For attending physicians at these two hospitals, who love walking into an examination room with their entourage, are able to use their superior health plans to in turn meet with their own doctors in private. They are then able to avoid the very practice which they defend so vigorously in dealing with their own patients.

What does it say about the attending physician, who patronizingly and condescendingly dismisses a patient’s objections over a medical student, intern or resident observing the session? What example are they setting for the younger generation of doctors?

And will these medical students continue to defend nonconsensual physician shadowing, should there come a time when it is they who wish to meet with a doctor in private and yet are unable to do so? Will they clap their hands with glee, when it is their doctor who proceeds to enter the examination room — not alone but with another person?

Moreover, one of the principal reasons why so many doctors prefer not to be alone in the room with their patients is so that they can later have a witness to protect themselves from lawsuits. How can even the vaguest semblance of privacy and trust survive this crude and uncivilized behavior? And what will become of the doctor-patient relationship that is completely devoid of trust and mutual respect?

Despite the fact that I have repeatedly told seven different departments at the first hospital that I do not give my consent to this, they continue to invite medical students, residents, and fellows to shadow many of my doctor visits. The other hospital — where I wouldn’t bat an eyelash should a medical student attempt to follow me into the restroom to watch me relieve myself — is even worse.

Many patients are also afraid to object, because of the hospital’s authoritarian policy prohibiting patients from changing oncologists within any given department.

The dismantling of the humanities has also greatly contributed to the problem because once a young person receives an advanced scientific and technical training utterly devoid of literature, history, and art they will inevitably be sucked into a vortex of amorality.

Nonconsensual physician shadowing also paves the way for further abuses, such as medical students and residents performing pelvic and rectal exams on anesthetized patients. This is because once medical students are inculcated with the idea that the patient is a mere teaching tool, there is no turning back from this road to perdition.

The pernicious influence of so many teaching hospitals has led to the indoctrination of thousands of young health care professionals with the idea that the patient is not a human being but a commodity that has no rights. And this dogma has spread throughout the entirety of American health care like a cancer.

Following an extremely painful liver biopsy, a nurse walked in on me while I was attempting the undignified act of urinating into a flask. What remains so hauntingly ingrained in my memory is the fact that she neither left nor apologized but became angry and defensive when I asked her to leave. This behavior underscores the total moral bankruptcy of so many health care professionals that work in teaching hospitals. And her complete disdain for my privacy remains vividly ingrained in my memory, as a metaphor for the barbarism which so many patients in this country are all too often forced to endure.

David Penner is a writer.

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