Amid the buzz about whether medical students should be sued and the bill currently debated in Arizona (a state which finds itself in the spotlight more than usual these days), I noticed some commentary from several people who do not think they would like a medical student on their case. Sometimes patients do refuse to be cared for by medical students, often due to overestimating the involvement they will have in their care. Indeed, there is an inherent tension between patient safety and the need to train future physicians. However, it is important to recognize there having a medical student caring for you may actually be a blessing in disguise. There are several reasons why you may benefit from having a medical student caring for you.
- You will have a complete history and physical on your chart– There is often not enough time for a resident or attending to do a thorough history or physical. Their documentation is not likely to be as complete as a medical student’s. Interestingly, the best friend of every consulting physician is the “medical student H&P” – the history and physical document that details all the major information about a patient’s stay. While patients often report they are ‘repeating’ their story to everyone they see, part of that is due to an incomplete history that necessitate treating physicians to delve a bit more to confirm the diagnosis. Unfortunately, with the advent of electronic health records, medical student histories are sometimes not part of the medical record. However, it does not have to be the case. At one of our community hospitals, our students notes do appear in the system and are able to contribute to the care provided.
- Someone will check in on you frequently and have time to listen to your questions – Because medical students don’t often have the caseload of the resident or attending, the student is able to pay more attention to you throughout the day. A third year student may be following only one or two patients at a given time. While it is true that maybe they don’t know all the answers to your questions, they can relay this to your team and often serve an invaluable role.
- They may make you feel better- Students are often less burned out and more connected to their patients since they are learning from each of their interactions. I’ve had students who really connect to patients through a variety of ways to help them heal, including reading to them or bringing them their favorite magazines or books so they don’t get bored.
- You may get fewer tests – While it may appear that a medical student may be associated with more testing, the truth is that the job of the medical student is often to ‘get old records’ from the outside hospital or the primary care physician. Unfortunately, this is very time consuming and hard to do and it is not easy to “check the record” as patients often ask us to. Maybe this will get better with electronic health records that talk to each other, but in the interim, we rely on our students. Unfortunately, residents do not have time to do this these days with the caseloads they carry. For example, last year, I had a medical student who secured the invaluable bone marrow biopsy on a patient from an outside hospital on a weekend(!) that saved the patient from getting an unnecessary and painful procedure. A few weeks ago, I had a medical student who secured a bevy of rheumatologic and hematologic labs on a patient with a suspected autoimmune process which saved us from having to redraw all of those tests.
- A student may actually make the diagnosis– Students are sometimes assigned to the ‘bread and butter’ cases (routine stuff) but are occasionally assigned to the ‘zebra’ – the interesting case that no one can figure out. While students don’t have all the experience that their more seasoned and older residents and attending have, they do have time to look things up and can sometimes make a breakthrough since they keep a wide open list of possibilities. Over the past few years, I can recall several instances in which a patient’s diagnosis was a mystery and a massive workup was ongoing with multiple consultants involved. In two instances, a student offered the correct diagnosis early in the patient’s course and found key literature to secure getting the right test. In another case, a patient who was in the hospital became very concerned about her nail findings (which was her number one complaint) despite having a serious heart infection. After some digging, our student figured out the diagnosis was Muerkhe’s nails, which is a finding associated with low protein, and he was able to reassure her that they would go away as her nutrition improved.
While some of you may still have concerns, it’s important to know that students are closely supervised by residents and attending, who are the ones responsible for your care. In fact, the patients cared for by students sometimes get more attention during rounds by the resident and attending. So if you or a loved one find yourself in a teaching hospital, consider asking for a medical student on your case.
-Vineet Arora, MD