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Voices: Full Disclosure

Mar 28, 2013

Full Disclosure | B.J. Rimel, MD

As a junior attending, teaching residents in clinic is one of the most frustrating and joyful experiences of my practice. Balancing the desire to educate with the ever present need to keep wait times down in a busy clinic leads me to sometimes cut off the protracted history-taking that residents inevitably perform, but I feel bad about it every time. The residents rotate onto the gynecologic oncology service for a few weeks at a time every year of their training, and with rare exceptions, our service is the only time that they will interact with gynecologic cancer patients during the residency.

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For some patients the opportunity to share their experiences with a new doctor can be very motivating, for others it’s simply another hurdle in receiving care in an academic center. I’m never sure how exactly to handle the exasperated patient who asks me to “not have any residents.” On the one hand, I can easily understand the desire to have only one doctor in the room, one who knows the history already and has already demonstrated their competence. Cancer is upsetting enough, why should a patient speak with anyone they do not wish to?

However, without training young doctors to recognize the subtle signs of ovarian cancer or the red flags of cervical cancer they will absolutely miss them in future patients. If they are not instructed in how to perform a gentle pelvic exam in a woman who has had radiation therapy, then they will needlessly discomfort these women in the future. I feel a deep obligation to train residents for the future patients they will see and to honor the legacy of those who trained me.

So, what do I say when the nurses in clinic come to me and say, “This patient says ‘no residents’ ? ” I go into the room alone. I sit down and say, “The nurses told me that you do not wish to have any residents involved in your care today. In the interest of full disclosure, I want you to know that I was a resident.” Usually, this gets a chuckle and the response, “Yes, I know, but you are so much better than they are.”

“Yes, I am. But I didn’t get this way standing out in the hallway. And besides, do you think I would let anything happen to you? I am right here.”

Most often, this is all we need to understand each other, a moment to laugh and a moment to recognize that we are part of something bigger.