Patient confidentiality and privacy should always be at the forefront of a physician's mind. When a medical student is shadowing during a patient visit, however, the lines of confidentiality can be blurred. How does the patient know that the visiting student will respect their privacy?
Patient Privacy Concerns and Disclosure
In a study of more than 2,000 adults published in JAMA Network Open, 1,630 reported withholding medically relevant information from their physician. Some of the top reasons participants gave for nondisclosure were embarrassment and fear of judgment. Women, younger participants and those with worse self-rated health were more likely to report that they withheld information.
If over 80 percent of patients withhold information in presumably private conversations with their physician, then it is reasonable to assume that even more people would withhold information if a third party were present, such as a shadowing student.
Patients must feel free to discuss their healthcare concerns in detail, without fear of shame or exposure, and with a physician who makes them feel respected and understood. Moreover, physicians and their practices have a legal duty to provide their patients with confidentiality and privacy. At the same time, shadowing is an important part of career development for future health professionals. A shadowing experience can help young people figure out whether they are on the right path. Pre-medical students may also need to shadow to decide which specialty to pursue.
Training Before Shadowing
Although students who will only be spending a few hours in a gynecology practice do not need the same training as a new employee, they need to understand the basics of patient consent and confidentiality. Here are some recommended guidelines for shadowing from the Association of American Medical Colleges:
- Observation must be supervised by a physician or another healthcare professional.
- Shadowing students may not perform any medical duties.
- Providers should respect patients' right to refuse to have a shadow in the room.
- Shadowing students must respect patient privacy and confidentiality, and may never share patient information.
It may be helpful to provide people who will potentially be shadowing with a brief HIPAA overview. This overview should include an explanation of local and national privacy laws and should outline the practice's legal responsibility to provide patient confidentiality. Physicians and students should discuss hypothetical examples of privacy or confidentiality violations. Finally, anyone shadowing should provide a signed, written acknowledgment of their adherence to the practice's privacy policy , along with a guardian's signature if they are a minor.
Securing Patient Permission
Patients may not expect to see a person shadowing in a private medical clinic. They may also be reluctant to tell their physician that they are uncomfortable with a student's presence in front of the shadow. A nurse or another team member who interacts with the patient should ask them for their preference; if this is not possible, consider asking the patient on an intake form or before the shadow enters the room.
Before asking the patient for their consent to have their appointment observed, explain why the student is there and what they hope to accomplish by being there. Assure your patient that your shadow has agreed to respect patient confidentiality. Be careful not to misrepresent a student's role; for instance, do not say they are a medical student if they are an undergraduate.
The patient should be made aware that they can request that the shadow leave at any time. If any exams will be performed, such as a breast exam, pelvic exam or transvaginal or transabdominal ultrasound exam, the patient should confirm whether the shadow may be present.
Patients need to be able to speak freely so physicians can accurately diagnose and treat them. Some patients will happily allow students to observe their care, but others may feel uncomfortable. Respect a patient's decision if they do not want a shadowing student to observe them, and encourage students to see every patient conversation as a learning opportunity.
