Moral Priorities in a Teaching Hospital
- Moral Priorities in a Teaching Hospital
JC, a thirty-five-year-old woman in the hospital for treatment of pain, fatigue, and unusual skin lesions, wakens suddenly as the medical team enters her room during their morning rounds. "Good morning, JC," announces Dr. A, the attending physician. "We have a whole team of people to see you today. How are you feeling?" JC shifts in bed and lifts herself a bit. She asks softly, "Who are all these people?"
"They're members of the team," replies Dr. A.
"Do they all have to be here? Can't I just talk to you and Dr. K, the one who admitted me?"
Dr. A explains. "Dr. K was the doctor you saw in the ER. You won't see her up here. These folks are students and new doctors learning internal medicine; they're here to learn. They're all members of the team taking care of you."
JC pauses, turns her head away from the students and residents toward the window; she appears exasperated and near tears. She pleads shakily with the Dr. A, "It's really not comfortable to have all these people in here hovering over me. I mean, is my condition rare or something? I don't see why all these people need to be here." She flops back onto her pillows, bites her lower lip, and tries unsuccessfully to keep from crying.
Dr. A walks toward the edge of JC's bed and touches the edge of the sheet that is clumped in her grip. "I'm sorry, JC. We caught you a little off guard here. You rest a bit, and we'll come back a little later." He motions for the resident closest to the door to exit the room. Two other residents, two medical students, and Dr. A follow.
In the hall, the students and residents exchange sheepish glances. "That was awkward." "Yeah, she feels really bombarded. What should we do?"
Dr. A considers. "Let's give her some time to calm down. Later I'll talk to her and see if she might be interested in getting some Xanax; that should help with the anxiety and stress. In the meantime, I'll get a chaplain up here. I think she could use someone to talk to." A third-year medical student asks, "Didn't she know that this is a teaching hospital? Isn't someone supposed to explain that to her?"
"There does appear to be some confusion about that," Dr. A responds. "Well, let's move on for now."
One of the chaplains visits JC that afternoon. JC also calls the number for the hospital's ethics consultation service and requests an ethics consultation. She tells the assistant who fields her call: "It just can't be right that all these people get to crowd in here and observe me like I'm a guinea pig."
Should patients be allowed to refuse to make themselves available for pedagogical purposes? If health care professionals in training are entitled to learn on or from patients, what is the scope of such entitlement? How should we look upon trainees' needs to learn from patients in light of—or in spite of—patients' vulnerabilities?
- commentary
If the Hospital Ethics Committee gets involved in this case, the most helpful thing it could do might be to initiate a discussion of the influences that resident and student training can have on patients. This case draws attention to questions that probe this issue: Which features of patients' experiences of illness should prompt caregiver-teachers to carefully consider whether and when it is appropriate to use a particular patient to facilitate trainees' learning? Do caregivers in teaching hospitals have duties to articulate, to patients or their proxies, the special hazards of teaching hospitals—that procedures might be performed by less experienced personnel, that patients might need to repeat information to multiple students, residents, or attending caregivers, and that caregivers might be accompanied by entourages of trainees who might also listen, observe, and touch? If a patient cannot consent to being used to facilitate trainees' learning—in emergencies or because they do not have decision-making capacity...
