A few months ago, Randy Cohen, The Ethicist (Sunday New York Times, 4/15/07), responded to a question from a patient who declined to have resident physicians involved during the office appointment. The surgeon said something about the patient's obligation to train the next generation of doctors, but the patient stood firm. The patient wrote to The Ethicist to see who was right. The Ethicist suggested that patients who don't want to contribute to the betterment of the physician pool in that way could choose some other way to contribute, like donating their bodies to science. Many letters to the editor followed, with all sorts of differing opinions.
I teach residents and students, so this issue comes up frequently in my practice. On the one hand, my primary obligation is to my patients. On the other hand, if patients hadn't allowed me to learn while assisting in their care, I wouldn't have the skills I have today. Much of what I know comes from having incremental responsibility for patients while I was learning.
Having a student in the office with me does change the interaction with my patients. I try to do my very best, since I am role modeling good patient care as I provide it (I hope). But I know that some patients won't talk about their most personal issues when a student is present. As it stands, I don't have students every day, so patients get me alone most of the time. But I am really grateful to those patients who welcome my students, and give of themselves to further my mission of teaching the next generation of physicians -- the ones we will rely on after I've retired.