Whither Privacy? Physician Shadowing in an Age of Moral Bankruptcy

Amazing Things are Happening Here.

— Motto of Weill Cornell and New York-Presbyterian

Countless times as a patient both at Memorial Sloan Kettering and Weill Cornell 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.

As there are experienced and inexperienced doctors, there also experienced and inexperienced patients. And as I have logged quite an impressive array of hours at NYU, Lenox Hill, Weill Cornell, and Memorial, perhaps it is fair to say without boasting that I am one of the former. And it has been unequivocally clear to me for quite some time, that it is profoundly unethical for a physician to invite other people to observe a patient’s session with their doctor, and to do so without first obtaining the patient’s consent.

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. Yet 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 health care professionals who believe that patients who wish to meet with their doctor in private should simply avoid teaching hospitals. There are hundreds of teaching hospitals in this country that serve millions of people. 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 develop a relationship of trust with their doctor? Do they have the right to a discreet and 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. And this would permit medical students, interns, residents, and fellows to continue to accumulate their hours of observation.

The problem is not with shadowing, per sebut with the fact that the patient’s consent is almost never obtained.

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 grave. For it will be extremely difficult – if not impossible – to ever fully restore it.

Should there be an unwanted third party observing the session, will a patient feel comfortable talking with their doctor about an embarrassing medical condition? Will they feel comfortable going over their different treatment options should they have a serious disease? Will they feel free to voice all of their concerns?

Many of the most enthusiastic supporters of physician shadowing ardently defend the practice, just so long as they and their loved ones are not the patients, and on the receiving end of it. For attending physicians at Memorial and Cornell, who love walking into an examination room with their entourage as if they were Henry V meeting with his nobles prior to The Battle of Agincourt, are able to use their superior health plans and connections within the medical profession, to in turn meet with their own doctors in private. They are then able to avoid the very practice which they so vigorously defend in dealing with their own patients.

There are a number of disturbing online blogs, where pre-med and medical students discuss their experiences with physician shadowing. Overwhelmingly their attitude is as follows: “I’m going to do whatever I need to do to get into medical school. And if a patient is extremely uncomfortable with my observing their session with their doctor, too bad.” What kind of doctor will be born from this shameless and soulless careerist, who has nothing but contempt for the patient – the one person whose feelings a good physician will make paramount at all times?

No one argues that student social workers and aspiring doctors of psychology should shadow an experienced psychotherapist, as such a practice would be universally regarded as being in diametrical opposition to confidentiality. And no one complains that as a consequence of this, there will somehow be no younger generation of therapists.

And 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 what message are these student doctors actually being inculcated with?

And will these attending physicians continue to staunchly defend this unethical practice, 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? It is regrettable that there are so many physicians in this country, who make no effort to treat their patients as they themselves would wish to be treated.

Moreover, the idea that patients are somehow in need of a “chaperone” is the very quintessence of sophistry. For 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 so as to protect themselves from lawsuits. Yet how can even the vaguest semblance of privacy and trust survive this crude and uncivilized behavior?  And what will become of a doctor-patient relationship that is completely devoid of trust and mutual respect?

Why is it that everyone has to sign off on this – the attending physician, the medical student, the intern, the resident, the fellow – everyone that is, except the patient?

When unwanted persons are observing a patient’s session with their doctor it causes the conversation to become distorted, so that instead of a patient talking with their doctor they are being talked at, as the pompous attending physician attempts to put on a show for his subordinates. And this commodification of the now nameless and faceless patient can have a profoundly dehumanizing and debasing effect.

If this refusal to ask a patient for their consent fails to constitute an egregious and unequivocal violation of patient privacy, then what does? And what’s next? Will a patient’s visit to their doctor be secretly videotaped for “educational purposes?”

In discussing this matter with the slippery chair of Cornell Dermatology, I asked him whether there were certain situations where he would personally object to having other people in the room when meeting with his doctor, to which he replied, “Of course!” So then why are the overwhelming majority of patients, except for a privileged few who have the best commercial plans, denied the right to meet with a physician in private when they go to this very institution? Indeed, this is indefensible on both moral and intellectual grounds.

The corrupting influence of so many teaching hospitals has led to the indoctrination of thousands of young health care professionals, with the pernicious idea that the patient is a mere teaching tool, and an object that has no rights. And this dogma has become pervasive, spreading throughout the entirety of American health care like a cancer.

Following an extremely painful liver biopsy performed at Memorial, 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 instead became angry and defensive when I asked her to leave. The behavior of this knavish creature underscores the total moral bankruptcy of so many health care professionals who 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.

Denied their inalienable right to privacy, the patient is stripped of all dignity, and the ethical foundation of sound medical care is dismantled and torn asunder. And the denouement of this farce, is that the patient is ultimately treated as though they were a slab of meat, and not a living breathing person with a soul.

David Penner has taught English and ESL within the City University of New York and at Fordham. His articles have appeared in Counterpunch, Dissident Voice, The Arizona Free Press, and Global Research.

He can be reached at: penadam@hotmail.com.

Read other articles by David.