Public Health Law Map - Beta 5 - Medical and Public Health Law Site

who make teaching a part of their practice should inform their patients at the first
patient visit that they are entering a teaching practice but that they have the right to
refuse to be cared for by students and residents or by a given resident or student.
Patients should not be introduced to a student and then asked if they are willing to
participate as teaching material. The patient should be asked first, out of the presence
of the student. Most patients are willing to participate in teaching, but the physician
must be prepared to honor the request of patients who do not want to participate.
Ethically, the patient’s decision to accept or refuse to participate in a teaching
program should have no bearing on whether the physician will treat the patient.
Linking the participation in the teaching program to access to medical care creates an
improper coercive atmosphere. Legally, the physician must honor the patient’s
refusal but may refer the patient to another physician if the referral would otherwise
be acceptable.
The physician should document the patient’s wishes as to participating in teaching.
Once general permission is obtained, simple consent is required before a specific
medical student or resident may participate in a patient’s care. This is obtained by
introducing the student to the patient and asking the patient if the student may
participate in the care. If the patient has concerns about privacy, the students and
residents should be instructed to respect the patient’s wishes. Some teaching
programs generally ignore concerns with privacy of medical information as regards
students and residents, but they are not excluded from either the state or federal laws
that govern access to medical information.
a) Faculty Physicians
Physicians who are medical school faculty without private practices must balance
the realities of their practices against patients’ right to choose who delivers their
medical care. This dilemma is exacerbated when the teaching program has assumed
the obligation to care for classes of patients other than those who voluntarily
choose to be treated at a teaching facility: emergency patients, indigent patients
(when the teaching program has charge of an indigent care program), and patients
with a contractual right to be treated, such as members of a managed care plan for
which the medical school has contracted to provide care. Persons in these classes
retain their right to refuse the care of students and residents.
Faculty physicians should obtain their patients’ permission to be included in the
teaching program in the same way that a private physician would. Except in
emergencies when consent is not required, this permission should be obtained
before the patient is seen by students or residents. In teaching programs with
insufficient attending staff supervision that rely on students or residents for primary
patient contact, the first person to see the patient should obtain the patient’s
consent. To lessen the implicit coercion in such a situation, the patients should be
told that they have a right to refuse care from a resident or a medical student. Most
patients consent to be treated by students and residents; the teaching program and
the nursing personnel must respect the wishes of patients who refuse this care. The
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