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Blog Post on Physician Shadowing Sparks Debate

Our recent blog post questioning the value and ethics of physician shadowing has unleashed an avalanche of comments, divergent perspectives – and even spawned a blog post of its own.

On February 14, 2013, Dr. Elizabeth Kitsis, a physician and bioethicist, openly questioned whether high school or college students considering a career in medicine or patients actually benefit from physician shadowing. Her viewpoint is informed not only by personal experience but by robust research examining peer-reviewed literature on physician shadowing that goes back more than 60 years and includes not just medical and pre-students but teenagers in high school. Yes, high school students actually shadow physicians in some healthcare facilities.

Here are highlights of the discourse from patients, premeds and doctors:

From Patients:
Via Twitter, Monique Hammond wrote: “Great piece!! This happens a lot. Would-be students also tag along as “scribes” taking “notes.” What? We can say NO & I have.” Monique added in a later tweet: “As patients we should be told who the “shadowers” are. No lies! We pay plenty for the doc’s attention & a bit of privacy.”

On Facebook, Lisa Brown responded, “Certain situations I would be ok with… my pride was pretty much out the window when they brought a parade of med students in during a pelvic exam lol. In fact one of the students actually said ” nothin’ like a parade huh?” when he realized how uncomfortable i might be. The joke definitely broke the tension, my doc even laughed.”

From Premed Students:
Mel Sherman is a biological anthropologist preparing for med school. This premed runs a blog called “afuturemd.” After reading Dr. Kitsis’ post, Mel was fired up. She wrote an entire blog piece in response. Here are excerpts from her post:

“In college, I searched for opportunities to shadow physicians or work in a medical office to simultaneously obtain clinical experience and pay for things like groceries or school supplies. The reason I shadowed/worked for physicians was because I needed “clinical” experience that would be deemed acceptable by a medical admissions committee.”

“For someone who is already a physician, Dr. Kitsis has probably become more far removed from the goals and ambitions of the pre-medical/post-baccalaureate student population.”

“I wish that Dr. Kitsis would know that there are students like me who had zero ties to the medical profession but are continually inspired by people like her. For one to discourage the plight of hopeful students who wish to shadow physicians is unfortunate but it is not a deterrent. If you are interested in pursuing medicine, you cannot leave any stone unturned when it comes to learning more about the profession.”

And Mel’s post inspired several insightful comments on her own blog: 

  • Jennifer Isaacs wrote: “When I read Dr. Kitsis’ article I did not see it as a message warning/deterring premeds from pursuing shadowing experiences but rather as directed towards her colleagues. The practitioner/physician is the one who can guide a shadowing experience in a professional manner. I have seen, many times, that a shadow was introduced as a student doctor. This is misleading as the patient feels that by denying the patient access to the exam room they are denying the “student doctor” an education. However by introducing the shadow as a student exploring careers, many more patients may refuse the shadow’s presence. I think that a physician can provide adequate clinical access to shadows while protecting the privacy of a patient by being upfront about the shadows presence and also removing the shadow from the exam room during more delicate procedures such as pelvic exams. There is no reason to abolish shadowing completely, but there are certainly better ways to do it. I can say for certain that I doubt my interest in medicine would have been better guided by viewing a pelvic exam in action. Furthermore, introducing a non-medical student as a medical student is unethical in my opinion.” 
  • Mandy chipped in with the following: “As a pre-med grad student, I’ve spent over 60 hours shadowing physicians as part of a student medical internship program at my school. Before being allowed to shadow at the hospital, we had to fill out paperwork and take brief online “courses” that discussed HIPPA, regulations, etc. in the hospital. I think shadowing is a great way for students to get a glimpse of what its like to be a physician. Most of doctors I shadowed introduced me as a student who was considering med school, and I never had a patient refuse the observation. Personally, shadowing was a great experience and it confirmed my desire to continue on the path towards becoming a physician.”

From a Med Student:
Amol Utrankar tweeted to us:  “My experience: patients in teaching hospitals are used to students. #MedEd is a big commitment + shadowing helped me make it.”

From Residents/Doctors Post Residency:
On Dr. Kitsis’ blog, Toby Winter M.S.R.N., F.N.P, commented:I think it is fine to shadow a physician but not in any situation where a patient is disrobed. That is totally inappropriate and unnecessary.”

Ruth Macklin, Ph.D., professor, Department of Epidemiology & Population Health at Einstein, also responded on the blog: “Physicians who participate in this shady practice obviously need some ethics education on the topic of shadowing–and introducing students to patients. Referring to a college student as a “student doctor”? Even medical students should be introduced as what they are: medical students, not “student doctors.”

She wasn’t the only Einstein faculty member to weigh in. Robert Roose, M.D., M.P.H., assistant professor, Department of Family Medicine, stated: “Yes. Shadowing doctors by lying to patients is wrong. With full disclosure it may be redeemable in some cases.”

Ryan Gray, M.D. U.S. Air Force said, “I think shadowing is a valuable tool for the premed student. In a day and age of House and Grey’s Anatomy, medicine looks fun. Students need to realize that it’s not all fun and games and that a majority of the time is spent outside of direct patient care. Why try to hide what is waiting behind the doors of the exam room?

Another reason is what I see as a growing trend in 3 year curriculums in medical school. Students need to be able to get the exposure that they may have received in their 4th year, earlier. They need to be able to pick a specialty with less time to decide and less exposure to the valuable electives that a 4 year curriculum affords them.

What your discussion should be more focused on is how to educate all involved on the proper way to introduce patients to the fact that an observer will be present if they will allow it.”

From Dr. Kitsis:
“I’m truly impressed by the depth of conversation this post has inspired and glad to see so many different parties in this debate represented. It is clearly important for students considering a career in medicine to know what lies ahead.  Being a physician in the new millennium is a privilege, but it is also a challenge, and it’s not for everyone, so learning all you can while you can is important. I am not sure of the best way to find out what it’s like to be a physician; however, shadowing as it is currently practiced in many places is not ideal. Changes in the system are clearly necessary. When weighing the potential benefits and harms of shadowing by high school and college students, those of us already in medicine must -as always – consider patient welfare first.”

What do you think about physician shadowing? Tell us by adding a comment below.

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  • Ryan March 25, 2013, 1:55 PM

    I have returned to school as an older adult on a pre-med track, and I am very hesitant about the shadowing pre-requisite, but maybe that’s because I’m already very familiar with the medical field and a physicians role in it. Dr. Kitsis has been the first I’ve come across to bring these reflections to light. I have been working in health care for a little over ten years now and the idea of shadowing a Doctor in their practice has always felt intrusive to the patient and a breach of privacy. While not all may feel that way about it, I think it’s completely inappropriate for patients to even be asked if they would permit an unqualified and useless stranger into the room during their exam and/or appointment. I believe that many patients would feel an underlying sense of obligation. Not everyone is equally assertive in expressing their true feelings on matters. While I certainly do see the value of gaining first-hand experience as a witness to the work of a Physician, the private clinical and procedural interaction is not the important part at this stage in ones education… Save that for medical school. I think it would be more fitting to partake in volunteer opportunities such as working as a patient transporter or such. This way, the applicant gets exposed to many different specialties in medicine as well as some nonintrusive patient interaction, not to mention an ‘interactive’ encounter in the health care field. This should at least be an option for some to take without penalty. I’ve been surprised at how medical school admission committees seem to stress the importance of shadowing without regard for the ethical considerations surrounding it. I believe there are many other ways to learn about what the profession entails without putting patients in a potentially uncomfortable and compromising position. I highly doubt that I will be fulfilling this particular requirement in the pre-med process, but I do fear it may count against me as most other applicants stack their ‘resumes’ with this otherwise questionable requirement, in practice and usefulness. That’s unfortunate… . Thank you, Dr. Kitsis, for raising awareness and consideration on this topic. Maybe there’s a middle ground in all of this.

  • Impatient Patient February 1, 2014, 8:09 PM

    As a retired instructor, I am always thinking “out of the box,” hopefully, and eager to assist younger people in their educational endeavors. About 3 years ago, I welcomed the unexpected “shadow” of my physician during a routine medical visit. Thinking back, it was pulled off in poor taste. There was absolutely no introduction of the “shadow.” I digress. While I waited in the examining room for my physician, there came a knock at the door, and thereafter a young person dressed in white with a stethoscope appeared, and merely stated they were working “with Dr.XYZ.” I’m rather easy to get along with and welcomed them in. They, too, were polite and inquired if they could interview me about the reason for my visit. They also had access to all my records (paper) over the last 30 years. In any case, I was thrilled to share with them anything I could thinking it would help increase their knowledge. After their questioning and prodding of my body and performing vitals, they left. My physician entered, eventually, and based on their notes, pronounced me healthy. He was in the room all of 3 minutes. I was not disturbed by this at the time. I felt as if I had perhaps contributed to the learning experience. Now, 3 years later, and numerous visits later, I have seen dozens of these people in white coats (about 20 different ones), and none of them are introduced. They all just barge in and start to examine me with little more courtesy than they would extend a cadaver. As for this patient, I have had it. I am dropping my doctor of 30 years and will make it clear to the next doctor I am not open to “shadowing.” I would not be so outspoken about this if the the “shadow” I experienced yesterday hadn’t been so rude and unpleasant. She had the temerity to go into a diagnosis modality and cause me considerable anxiety. What? Just because she had on a white coat and a stethosope. I will NOT cooperate with any medical facility (teaching school or otherwise) who allows shadowing.