First of all, I’m sorry for the clickbait title, but I just really wanted you to click on this one. I’m really mad. I started off being mad at a person, which is much easier to deal with, but I ended up being mad at a system, and that’s a lot harder. Let me tell you what happened.
My wife decided to go to a dermatologist to get her skin checked. Her father died of skin cancer when she was 12, and her entire family history is full of various cancers, melanoma in particular. We want to stay on top of all skin things, so she decided to go get checked up. She made an appointment at the only game in town, the state-wide monopoly of health care, the University of Vermont Medical Center. They are buying up other hospitals and small practices like they’re going to be eBay collector’s items someday, so there really are not a lot of options when it comes to health care around here.
My wife walks in, having specifically chosen a female doctor with whom she hopes to build a relationship, assuming that skin is going to be something we will check on frequently over the years, and she wants to have some consistency and continuity in care. She starts to get undressed, when two or three medical students walk in to check her out before the doctor comes in. This is not something my wife is interested in, so she asks to just see the actual doctor.
Before I get to the fight, let me give you a little background. My children have both seen a lot of doctors in their time, and we have spent many, many hours in appointments, telling the same story over and over again to a parade of interns, students, residents, and trainees. It sucks. It takes a lot of time. We pop over on lunch breaks, hoping to get in and out of there, only to be sat down in front of three different people in one appointment, all of whom are asking the same questions. They are practicing. I know this. It is important. But why am I paying for it? I pay with, first of all, my money. We are paying for this care, through insurance, through deductibles, and sometimes out of pocket. I am not interested in paying to be a test subject for your med students. I also pay with my time. Appointments that could take 20 minutes take 90. We sit in room after room, often with small, antsy children, for very long times as we have to recount our same information over and over again. It is infuriating. And finally, we pay emotionally. I don’t think I can understate the emotional toll of having to repeatedly recall the worst parts of my life. And it is not just one visit. Every time we go to an appointment, some student asks us to talk about every seizure our children have ever had. I want to leave most appointments in tears. It is grueling, it is exhausting, and it is, in my opinion, unethical.
So with this in mind, my wife, who was late for work already and did not look kindly on huge wastes of her life like these medical students, asked to just see her actual doctor. She was very polite. She said, “No thank you, I would prefer to see my primary dermatologist.” And they said no. They said she had to submit to being examined over her entire body by, well, pretty much anybody (and as many of them) that walked through the door. So she refused again, and they rushed out of the room in a panic. Thirty seconds later, the doctor appeared. The doctor was not happy.
Dr. Effyu told my wife that this was a teaching hospital, which meant that there were students here who were going to check her out first, so that they could learn. My wife said that she understood this, but today, that day, she would rather not go through all of that. The doctor told her that if she would just submit to the demands, it would go a lot better and faster for her. My wife said, from experience, she knew that this was not true. Having four exams would not be as fast as having one. And then the doctor told her to leave. Go somewhere else. She did not get examined. She did not establish a relationship with a dermatologist that she would rely on for years to come. She got threatened and kicked out.
The thing is, there really isn’t anywhere else to go, so I decided to look up online whether patients had the right to refuse having a crowd of college students paw over their naked bodies. It turns out, they do not. At least not here. In the patients’ rights document on their website, there is a paragraph addressing this. It states:
UVM Medical Center is a teaching hospital with a mission of educating health care professionals. Students and residents from multiple disciplines will be an integral part of your health care team.
So too bad for you if you don’t want that. You do not have any rights when it comes to who is providing this most private, personal, and vulnerable of services. I can’t even begin to tell you how angry and frustrated this makes me. My primary care physician has been bought up by the medical behemoth that is the University of Vermont Medical Center, and there are generally students involved at my appointments, but they always ask me if it is okay for them to be there. I never guessed that I wasn’t allowed to say “no.”
There are many articles, papers, and documents that can be found online and that deal with this very subject. You will probably not be surprised to find that there is a clear dichotomy of opinion on this matter. Patients overwhelmingly feel that it is unethical to be unable to refuse care by a resident. Doctors and hospital administrators overwhelmingly feel that it is unethical for a patient to be able to refuse care by a resident. How could they make more money if they could not exploit their patients as free training subjects for their students?! The whole idea is preposterous! Imagine, civilians having some sort of say in how the doctors make money!
When it was just one a-hole doctor making trouble for my wife, it seemed like something we could deal with, but now that I see the whole system is rigged against us I begin to lose hope. I like my doctor, but I’m going to look for someone else. I’m going to find one of the last few remaining private practices left that are not overrun by corporate plutocracy and I’m going to pretend that I have a choice in what happens to my body. I’m fed up. And if you happen to go to a doctor and they send you a resident first, try saying “no.” See what happens. If enough of us refuse, we may have a chance to change how things work. Or else we will all die young and they will harvest our organs for profit. At this point I wouldn’t be surprised.
UPDATE: We have since been contacted by the hospital, and they are very sorry. They assure me that, despite what it says in their patients bill of rights, we certainly should have had the option to decline being seen by a student. This is good news. Also, my wife would like me to clarify that the students themselves did not try to force their services onto her. They left fairly quickly to get the doctor. It was the doctor who refused to see her and told her that she must be seen by the students first. No one is upset with the students. That doctor, on the other hand, is still the absolute worst.
Please accept my apology for your experience; what you described is not the protocol we expect our staff and providers to follow.
The University of Vermont Medical Center is one of approximately 135 academic medical centers across the country engaged in educating and training medical students, residents (medical school graduates who are licensed physicians in post-graduate training), nursing students and students in allied health professions.
As teachers, our physicians actively engage residents in the care of our patients. Medical students are often present as a necessary part of their clinical rotations.
Patients have the right to refuse to be seen by residents or students and we will respect that right.
We will follow up on the experience you have described.
Lisa Goodrich
Vice President
Medical Group Operations
Thanks for responding. It’s good to know that this was not the normal and expected response. We were a little worried when we looked at the patients rights statement, and saw nothing about the right to refuse being seen by a student. I have since heard from many people who tell me that this should not have happened. I do feel better.
First off patients “rights and responsibilities” is NOT a binding contract. Patient rights are written in federal and state law (such as the Affordable Care Act). Hospitals try to “trick” patients by putting what they deem “responsibilities” next to your rights. While some “responsibilities” are written in to law (like paying your bill), most items there are not.
This is like the caveat of insurance; “the big print giveth, and the small print taketh away.” If you read many of these “rights and responsibilities” statements, you will find conflict between rights and responsibilities. For example, you have the right to participate in your healthcare plan and decisions, but you MUST do what your doctor tells you to.
This is the same attitude that made common practice medical students conducting a pelvic exam on an anesthetized woman without permission. (Source: http://www.ajog.org/article/S0002-9378(02)71415-4/abstract?cc=y= )
Feel free to contact me and I can give you some more good references on how to protect yourself and links to research that shows why doctors think like this.
—Archie Banterings