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October 10th, 2011
09:24 AM ET
Student doctors practice on you while you sleepAnthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.
As a plastic surgeon, part of my job includes the art of suturing. Over the past 15 years, I’ve repaired more than 10,000 cuts, incisions, bites, and wounds. I’ve seen it all — people who’ve been sliced by beer bottles, attacked by wild animals, and even injured by — I want to be delicate here — “personal, intimate devices.” I’ve done so much suturing that sewing up people has become second nature. I can repair a dog bite to the face blindfolded. I began by learning how to tie surgical knots. I had never been an Eagle Scout or a sailor so my experience tying knots was limited to looping the laces on my Nikes. I started with a “knot-tying practice board.” The board consisted of shoelaces and a simulated surgical incision made of plastic and rubber bands. The first time I picked it up I felt as if I had six thumbs on each hand. It took several hours, but at last I got a feel for tying knots. Then I became proficient. And then I became a knot-tying wizard. Next step, the real deal. Suturing. Many hospitals save their old, unopened sutures so their industrious students can practice. In order to impress the surgeons and get a good grade, I had to dazzle them with my suturing skills. The pressure was on. First, I collected a ton of unused sutures from the hospital. Then I borrowed some surgical instruments from my father, an ob-gyn. Finally, I went to the local butcher shop and bought a dozen pigs’ feet. I brought them home and stuffed them into my freezer. Why? The texture of the skin on a pig’s foot is very similar to human skin. Every evening I’d come home and practice. I’d cut the pig’s foot with a steak knife and practice stitching it together, over and over, countless times, until my fingers got sore. If the butcher didn’t have any of Porky’s piggies, I substituted chicken breasts, a decent alternative in terms of skin texture, and much tastier. By the time I started my third year, I was ready for real live human beings, who thankfully, for both of us, were usually fast asleep. The first person I ever sutured was a young mother who allowed me to repair her surgical incision while her ob-gyn supervised. I’ll be honest. I was a nervous wreck. My hands trembled, my pulse raced, sweat dripped down my forehead. For a moment my vision blurred. The simple incision whirled, expanded, and contracted. I felt as if I was peering through a kaleidoscope. Then I closed my eyes and pictured my trusty pig’s foot. I visualized myself suturing. I opened my eyes. I felt calm. I took a deep breath. With the doctor guiding me, I tied a perfect surgeon’s knot. I began suturing, slowly. Smoothly. Effortlessly. That moment — the first time a nervous, inexperienced medical student sutures a live patient — is not only a common occurrence, it’s a crucial component of a surgeon’s education. In order to become excellent surgeons, medical students need to practice on real people. Full disclosure. If you are undergoing surgery and you meet a medical student prior to the procedure, it’s likely that student will practice suturing on you. I’ve been that student hundreds of times, however, unless the patient asked, the surgeon never openly admitted to the patient that I was going to be the one doing the suturing. The surgeons often omitted this important piece of information to avoid the patient needless worry. I often would lie awake at night concerned that the sutures I tied that day would unravel, the incision would open up, and the patient’s guts would fall onto the floor. Although this never happened, I wouldn’t want the patient worrying about the same thing. Truthfully, the surgeons who oversaw me always made sure that my suturing turned out exactly the way they would have done it themselves. Of course, a patient has rights. A patient can refuse to allow a medical student to participate in his or her care. I understand if a patient feels uneasy allowing a medical student to suture while the patient sleeps. But to those of you who allowed me to practice on you when I was in training: My patients today and I thank you.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love. Recent Comments
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Autumn. The air turns cool and crisp, leaves change color, and third-year medical students descend on hospitals to learn to be real doctors… by practicing on real people.
That's a big "so what"?
He is trying to sell a book probably as stupid as this article.
I choose to decline care from students/residents/fellows/interns/crna/srna....I put this on the consent and the attending signs it. No problem, better care wuth tons less stress.
What a waste of space. What a stupid article. Who cares.
He is trying to nicely tell patients to suck it up and help the students out... let them practice, your doctor is going to be right there helping him the whole way. Otherwise, in 20 years, you better be prepared for a lot of crappy untrained physicians and surgeons.
well all you rude people i liked this article!!
There was a big news story a few years ago about student docs doing pelvic exams on female patients....even if that type of surgery wasn't why they were there. The women weren't asked for consent, or told it was done. That's RAPE. I will never let a student experiment on me.
Teaching hospitals' typical patients present to the ER and do not have a primary physician. A pelvic exam is part of the complete physical that should be a part of admitting any unfamiliar female patient. There are no unrelated problems. We don't take care of problems–we take care of <bpeople. An abscess on the foot may be the event that brings a woman to see a physician for the first time in years, and if you don't find the undiagnosed pelvic mass, it may sit undetected for several more years. In my training, I did many pelvic exams on women with non-gynecological disease. I found something deserving attention twice. Those two women made the other exams worthwhile.
The man who taught this to me and thousands others died last week. Heavens knows how many lives he saved by telling us to do "unnecessary" pelvic exams. JWH, RIP.
So EUSM '82, did you do the "unnecessay" exam of the prostate on males too? Or is it that you just found the female pelvic exams more interesting?
If I remember correctly, that was for Ob/Gyn patients who were anesthetized for a procedure getting extra pelvic exams by medical students. Pardon me for being indelicate, but if you are about to have a procedure on your uterus, that means your Ob/Gyn is about to stick a camera and all kinds of surgical instruments up there. The medical student may be assisting by holding retractors, so they will be up in there anyway. I understand it's a private part of someone's anatomy, but if you don't want students in there, then don't go to a teaching hospital.
HH, is that the story that came out of Canada? If I remember correctly, the complaint was that a high of women were not hospitalized for ob/gyn surgery and were not indigient patients. They were not informed of the exams and the hospitals in question were trying to bump up the numbers of exams med students did. No one questioned the importance of a regular pelvic exam or the need for med students to learn to do them, but the practice of not informing patients prior to anesthesia was the issue.
Personnally, I have a primary care doctor. If I went in for gall bladder or knee surgery & found out after the fact that a med student had performed an unneeded pelvic while I was unconscious, I would file a complaint.
Lost of issues here. I remember learning to suture in medical school. We were always supervised. I sewed up an incision on a woman who had a breast biopsy while she was awake. I was nervous but did it well. Then I said the surgeon "Good enough". That was a wrong thing to say with the patient listening. The surgeon said in response "perfect" Regarding pelvic and rectal exams: they are standard when admitting a patient and we did them all the time. One of the only lives I saved was when I insisted on doing a rectal on a patient (who turned out to be the father of the CEO of the hospital) being admited for asthma/COPD. He was angry. Well, I tested his stool for blood and he was postive. He had his cancerous tumor removed a week later and was cured.
I think priorities are being misplaced. Pelvic exams are an important part of a physical, as invasive as many people think it may be, it is necessary. Now, to the address the point of students performing exams on patients. The most important learning experience of any medical student is to have hands on experience, and without this, future physicians will suffer and so will patients. Everything a student do is supervised. The amount of experience and trust from the team will decide what the students get to do. I understand that it will probably make any patient uncomfortable, but many hospitals have medical students on their team and the patient can request a student not to perform procedures on him/her.
Now, to the statement made by Terry. Unfortunately, it is hard to distinguish sarcasm on the internet, but I will take your response as flaming sarcasm. If you think any health care provider is doing a pelvic exam cause we found it "interesting", then that is a real shame and devalues the purpose of the any healthcare profession. Tests that may seem invasive have saved lives and will continue to save lives.
wow very interesting
I kind of find this funny for some odd reason. A awesome blog. Thanks for the awesome article! This website is like the cookies to a glass of tasty soy milk. From reading your article, I can tell you're really devoted to the craft. I even found myself shocked and dismayed by how people reacted.
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Student doctors do pelvic and rectal exams, both are part of regular preventive care and can catch cancers early. I certainly never did a pelvic or prostate exam on a patient who wasn't awake and knew exactly what I was doing, of course, but most patients were fine with it. In fact, when you have a student doctor involved, you often get much more attention because you have several eyes on your case rather than just one harried doctor in a private practice.
Oops and I wanted to reply to the actual article. I remember suturing pigs feet and begging scrub techs for the extra sutures left over from surgeries that would be thrown out later. I remember sweating and my hands shaking the first time I sutured a patient myself (with plenty of supervision, important caveat there!) And then I remember how awesome it felt when the sutures actually looked the way they were supposed to and the surgeon told me I'd done well. I did not become a surgeon, but it was still thrilling and something I will never forget.
As a physician, I can safely say that having a medical student part of the team is much more advantageous. Medical students go out of their way to obtain a full detailed history, much more detailed than physicians. Its not that attendings are inept, its that many times the extra information is irrelevant. However, medical students many times pick up things we would of never caught and allows for better treatment. No not life or death issues, but small subtle details especially regarding home situation or a more comprehensive differential diagnosis.
Medical students do this because they have much more time to spend with patients and are extremely thorough because they are not sure what is and what isn't relevant. It also provides patients with comfort knowing medical staff spend more time with them. Patients that refuse medical students or even residents will many times get the same amount of time from the attending physician simply because the attending is just too busy. But having more players on the team allows for more thorough workup and treatment.
Patients need to be aware that a student might be practicing on them. Even if it's included in the paperwork most patients sign off on before they go into surgery, patients still need to be informed. It's the right of the patient to opt in to have a student treat them instead of opting out. I understand the need for medical training. My last surgery was done in a training hospital and the attending was very clear about asking me my opinion about having students in on the procedure. It provides dignity and a bit of control to the patient who often is put in an undignified, uncontrolled position of vulnerability when they're unconscious. Yes, I did say the students could practice on me; I appreciated the respect the attending doctor had for me as a person instead of just a patient.
Let me tell you something you arrogant doctors who are commenting on here: You have NO right to do anything to anyone without their consent, no matter how you try to justify it! GET OFF YOUR GOD COMPLEX!!! Who do you think you are!!? I'm so sick of obnoxious, egostistical doctors! If anyone goes to a doctor and they do get better, it's a lucky coincidence! Doctors have a long, long history of horribly abusing their patients, rationalizing about it and then getting away with it. Doctors bury their mistakes.
They say that Jack the Ripper was very likely a doctor, a surgeon, and that doesn't surprise me at all!
shut up
Then I hope you never have to go to a doctor, if that is the kind of opinion you have. In fact even if you are sick, please don't go.
I agree 109% with you
Medical training is a very complex issue in my view.
Medical students and physicians in training need to be exposed in order to become clinically competent to practice in the future.
Now, I believe mutual respect is always key in everything we do...Students should be taught not only about the book knowledge of medicine but more importantly focus in the relationship with patients... Good communication is key in obtaining trust.
I do have to say I owe my training to thousands of patients who were understanding enough to allow me to practice during their medical care. But this practice has to be closely supervised...so there is a balance.....
I do agree that some of our colleagues in the field really lack of proper bedside manners....leading to unpleasant experiences reported by patients.. This is the area medical schools should work more...by selecting more well rounded students looking beyond just grades....
Overall the majority of doctors chose the profession to serve...and I feel they have genuine concern for their patients...
I always add to my consent: "I am not consenting to thte prescence of or treatment by and students, interns, observers..this includes residents, fellows, SRNA or anyone else who is not fully credentialed in their area of expertise". This always works.
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Dear Kim:
You don't deserve us. But when you are ill, we will take care of you anyway
signed, the medical profession
Well said, MK!
"Kim" is likely an ER frequent-flyer who's been turned away one to many times for her Percocet refills 🙂
I think each and every patient should be aware of such happenings. It's my decision and responsibility to keep up with Gyno visits, if I decided not to keep up, I wouldn't want a hero to by chance find something wrong. It may be just another body, just another unaware patient to you, but that's the problem with Doctors, they do not respect the human body, they are like mechanics to a car. It's a job!! Some people are not aware of certain things, most patients do not read all of the 5,000 pages of fine print before they sign. I'm not choosing a side, I'm neutral, YES these Doctors need the training and experience, but violating people is not a way to go about it!!!! I'm hoping things will be mentioned to patients. I wouldn't want to be a guinea pig!!! Sorry, I didn't sign up to be a test dummy, and I'm so glad I read about this nonsense, I having surgery this week!!!!! 🙂
*I'm
SJ,
That's fine if you don't want to be a guinea pig, but just understand if everyone made the same decision as you, the people that follow you (your kids, grandkids, etc) will inevitably be guinea pigs since doctors won't get the training they need. It's as simple as that. Medical students aren't just given a scalpel and told to have a field day. They also aren't strapping gloves on and looking for women to do pap smears on. There's a very set and rigid hierarchy in place that has more or less been followed for decades, and this type of structure and training is necessary for medical students to evolve into doctors. With this hierarchy comes accountability, so again, please don't think medical students are running around haphazardly in these hospitals.
Regarding your comment on doctors being mechanics– in some ways they are, but saying they don't have respect for the human body is a blanket statement that is simply not true. Honestly, if I get into a car accident tomorrow, the only thing I want my surgeon worried about is how to fix me up so I survive. I don't him/her worrying about the lawsuits that may take place because I didn't give consent for a medical student to touch me, or some other nonsense that in the end won't have any bearing on me surviving. If a surgeon was going to let a medical student operate on me, I would imagine he would know when and how to intervene. If you don't trust that much out of your surgeon, then go to another country to get care, because I'm sure their doctors will care about all your feelings and desires before cutting into you.
Very well said.
SJ you are exactly what I detest about the medical profession. Again I think it was said before . I don’t owe you or other generations anything and certainly not my body. I own it not you .. I have rights .. plus on top of this a profession who kills over 400 thousand innocent patients per year due to malpractice and incompetence injuring millions more per year should just shut up.. Does it surprise anyone that they violate patients rights when the are under anesthesia . That means nothing to them they think they are gods . But I know you are just stupid schmuks like the rest of us. You Morons think because you picked up a medical book instead of something else makes you better then the rest of us.. news flash !!! You are not!!!!
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Great post. I will be experiencing many of these issues as well..
I will never again allow a teaching hospital to perform a surgerical procedure on me. Since it was a delicate surgery involving my cornea, I requested that no student be allowed to complete any part of the procedure and the doctor agreed and then allowed a student to do the entire procedure. I am having complications that are causing pain, diminished vision and will likely have to have another surgery to correct it. I learned of this when I requested the doctor's notes, and also found the he had warned me of several things we never discussed, and that the complications were not mentioned on his report. To add insult to misery, it was twice what this surgery would have been in a private practice. Think twice about a teaching hospital.
Just add this to your consent: "I do not consent to any students, trainees (including residents, med students) or observers to participate in or to be present during any aspect of my care"........This is essential for any surgery or for any procedure. My wife was scheduled for fibroid surgery and the surgeon agreed t the above; this was at a large University med center....on the day of surgery (I was in the observation deck) and entire throng of residents were about to assault my wife with "exams and procedures" that were not necessary for her surgery....I intervened and the surgeon kicked the students out........my wife (A NP) was mortified that her consent had been violated and she got off the gurney and walked out (much to the chagrin of the staff)..........We have private insurance and are free to refrain from having students practice/learn on our bodies....A complaint to the Chief of Staff was initally ignred until one of the OR nurses pointed out that my wife had added "I do not consent to any students, trainees (including residents, med students) or observers to participate in or to be present during any aspect of my care"........to the surgial consent.......her consent was totally violated and she's really mad...do you blame her? A woman undergoing surgery is free to refuse any and all trainee, resident, student participation...but when you are under anesthesia, they do whatever they want? A SRNA and several residents are facing board action over this violation of patient consent. This is disgusting.
When it comes to teaching hospitals it seems like everyone just drank the Koop aid. There is a common misperception that the care is far superior in teaching hospitals. This is actuall not true when you look at the data. Teaching hospitals are more expensive and do not have better outcomes significant enough to warrant the extra expense and extra trouble to the patient of being a teaching subject. My husband had surgery in two teaching hospitals and I had surgery in one teaching hospital. None of the experiences were even remotely positive and I suffered a medical error at a large teaching hospital. When I delivered our children I went to a private hospital. The difference was night and day. I would never voluntarily set foot in a teaching hospital ever again.
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I would like to be a patient for surgeries to be training on
I am looking for a less expensive way to have my face lifted ! My aunt had her face done by students who practice facial surgery Can you tell me and or direct me to someone who will help me in this matter ?
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“Then don’t go to a teaching hospital.” Some patients have no choice, because that’s all their insurance or medicare will cover. In my city ALL the hospitals are affiliated with local medical schools. Patients, regardless of your opinions, own that body – NOT YOU. My body is not your curriculum guide.
I do not owe you or future generations or anyone else the use of my body. Why don’t you offer to pay patients, or offer reduced fees, if you need or want to practice? You are the person receiving the benefit.
To those of you using the defense that you found something – did you inform the patient that this was because of students practicing on them? I bet you didn’t. It was almost certainly phrased as your discovering it as part of routine procedures or some such wording. You didn’t tell them, “oh, by the way, we let a med student unrelated to your care stick his fingers in your daughter’s hoo-hoo while she was asleep because he wanted to practice a gyn exam, and he found endomeyriosis while he was there.” Admit it.
If you lie to us about what you do to out helpless, anesthetized bodies, how can we expect you to be trustworthy about anything else? You have no respect for us as your patient CUSTOMERS.
I as a patient I would never allow students to work on me.. My health is way to important. I am not a guinea pig or circus animal .!