Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The ethics of trainee-patient encounters: Are we practicing on the poor?

Nicole Van Groningen, MD
Education
August 1, 2014
Share
Tweet
Share

I performed my first paracentesis in November of my intern year.  It was 3 a.m., and I was on overnight call in a packed ICU.  The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name.  He didn’t know I was an intern.  He didn’t know I’d never even attempted a paracentesis before.

After I finished, I added the patient’s name to my procedure card.  I hurried to get an ABG on his neighbor.  I placed an NG tube in a GI bleeder. My senior resident and I never even wondered if our patient had a right to know how green I was.

Months later, at a meeting with residents and faculty in my internal medicine residency program, the discussion turned towards the ethics of residency training at teaching hospitals.  The idea that trainees treat patients who may have little to no understanding of what it means to be a “resident physician” can be morally unsettling.  The medical profession has traditionally overcome this by accepting a level of deception by omission for the sake of physician training.  Patients are our teachers — whether they realize it or not.  By submitting their trust to our profession they provide trainees with an invaluable service: The practice needed to become strong clinicians.

But who exactly are we practicing on? A study in the Journal of Family Medicine found that patients of resident physicians in an ambulatory care setting were younger, more likely to be non-white, and more likely to be reimbursed by Medicaid.   The Journal of Academic Medicine recently reported that minority patients were over twice as likely as white patients to be admitted to teaching hospitals.  This data begs an unsettling question.  Are we, as one resident asked at our recent meeting, practicing on the poor?

At the cornerstone institution of my internal medicine residency program, a New York City safety-net hospital, we treat an overwhelmingly low-income, homeless, and minority population.  As residents we pride ourselves on the level of autonomy we have in directing patient care: attendings’ roles are supportive, not managerial.  But the fact remains that we are not fully trained physicians, and the proportion of patients who truly understand this is unclear.

This leads one to wonder if care delivered by trainees, under the supervision of attending physicians, is sub-par.  The answer, according to the literature, is probably not.  In fact, the body of evidence on the matter suggests that quality of care at academic teaching hospitals is likely superior to that at hospitals without trainees.  A recent study in Medical Care found a 10% relative reduction in the adjusted odds of mortality from myocardial infarction, heart failure, and pneumonia for patients admitted to teaching hospitals when compared to non-teaching hospitals.

Data such as this reshapes the question of whether we are, in fact, practicing on the poor. Considering the evidence that care delivered by trainees is just as good — if not better — than that delivered at a non-teaching hospitals, one faculty member at our meeting mused, “if we are indeed practicing on the poor — lucky them.”

Nicole Van Groningen is an internal medicine resident.

Prev

Law and medicine are more intertwined than they should be

August 1, 2014 Kevin 4
…
Next

Scribes put humanity back into the practice of medicine

August 2, 2014 Kevin 67
…

Tagged as: Hospital-Based Medicine, Residency

Post navigation

< Previous Post
Law and medicine are more intertwined than they should be
Next Post >
Scribes put humanity back into the practice of medicine

ADVERTISEMENT

More by Nicole Van Groningen, MD

  • Physicians as innovators: 6 ways we help and hurt ourselves

    Nicole Van Groningen, MD
  • Female leaders in medicine: It’s lonely on top

    Nicole Van Groningen, MD

More in Education

  • Why clinical research is a powerful path for unmatched IMGs

    Dr. Khutaija Noor
  • Dear July intern: It’s normal to feel clueless—here’s what matters

    Tomi Mitchell, MD
  • Why medical schools must ditch lectures and embrace active learning

    Arlen Meyers, MD, MBA
  • Why helping people means more than getting an MD

    Vaishali Jha
  • Residency match tips: Building mentorship, research, and community

    Simran Kaur, MD and Eva Shelton, MD
  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 24 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The ethics of trainee-patient encounters: Are we practicing on the poor?
24 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...