My H recently had a dr. appt. where the dr. tagged along an intern. The young man was introduced as an intern, took medical notes (on the computer) for the dr., sat in on my H’s examination and medical history etc. The dr. left the room for a minute and I started chatting w the intern. I asked him where he was in med. school and he told me he hasn’t applied yet. He said he is on GapYear and will be applying shortly.
At the time, it didn’t bother me and I didn’t give it a second thought. It wasn’t until later that it struck me about the ethics of having a non-medical person with full access to H’s records etc. Is this ethical / a violation of HIIPA, standard practice etc. ?
Pre meds are being encouraged to take GAP years and intern these days.
I don’t see a problem with it. If a nurse tech was doing the same thing would you care. And the medical receptionist at the front desk can read the history form you fill out and be involved with entering your records.
The intern at least has bs in a science somewhere and the doc thinks they are on the ball. Or they wouldn’t be there and threatening their practice.
It sounds to me like the intern was scribing for the doctor. My DD was a scribe in a hospital for a year before entering med school. It’s excellent experience and frees up the doctor’s time.
Most likely the intern is someone’s relative or friend (from that office or hospital). It is very hard to job shadowing any doctor, due to the issues you mentioned and the potential hassle. As D painfully found out, she can’t find a job shadow by herself. Even with our network of friends, some told us that they no longer sponsor that.
D had to complete compliance and HIPPA training before she was allowed to intern. So rest assured, it should be fine from that perspective.
In my opinion, there should not be ambiguity - intentional or otherwise - about the student’s status (in this case, he wasn’t even a student!) If you are going to assume that a so-called “intern” is a current student in medical school (a reasonable assumption) the individual should at least be introduced to you in a non-ambiguous fashion. I can’t recall the terminology, I think perhaps “trainee” was used, last time I was at the dermatologist and my PA was accompanied by someone else.
I think in a corporate setting, if you are introduced to an “intern” you can safely assume the individual is a college or even high school student performing menial tasks in an unpaid temporary position. In a medical setting, the word “intern” usually means something else.
Actually, in medical terms, an intern is a doctor–first year resident. I believe it is grossly misleading to use the term in the general contemporary way of “interning” that students do.
There needs to another term. An intern is a doctor.
@privatebanker Not necessarily. There are plenty of medical school wannabes who do not have a BS in a science or science related field, but have taken the required courses for Med school admission…and are taking a gap year.
I hate to say it…but everyone’s summer job these days is called an “internship” and not all are doctor related @garland
Right, but as I said, the word has a particular meaning in medicine. And the doctor knows it. The kid can say whatever he wants, but the medical person should know better.
It’s not HIIPA, nor is it HIPPA. It’s HIPAA. Just a useful FYI.
If “the intern” was doing a task for the doctor, he would be considered to be part of the “team” taking care of your DH. Your DH could have at any time asked him to leave and not be involved in any aspect of his care if he was uncomfortable with it. One does not have to be “a medical person” to have legitimate access to a person’s medical record. You do realize that doctors have “non medical” personnel who do administrative tasks that involve PHI, right? If the young person was there by permission of the doctor and your husband didn’t object to his presence, there is no HIPAA violation that I can see. I think it would have been better, however, for the doctor to introduce the young man, his role at the practice that day, and ask if your DH had any objections to his presence.
My main objection is to calling someone an “intern” in a medical setting who is not a first year doctor. In the medical world, an “intern” is a doctor just beginning his career after graduating from medical school.
In my husband’s practice he teaches PA students for a six week rotation. He started doing this several years ago and really enjoys it. He has a form that he gives to each patient prior to the student going into the exam room to get the patient’s approval. He has become very popular at the PA school, with students requesting him for their OB/GYN rotation. And yes, an intern in the medical field is known as a first year doctor. I believe it dates to when doctors did a year’s internship before starting their practices and/or residencies.
Every time a young person joined an appt, the doctor first asked me for permission. I think that’s protocol.
This isn’t about access to your medical records as much as access to you, your supposedly private convo/exam. Even your private body parts. Sure, a nurse or med assistant may be involved, but as part of the trained team. That’s a big difference.
This issue is more important than it may seem on the surface. Clearly, the original poster was slightly uncomfortable sharing their health information without a full understanding of the roles of the people in the room. One should not have those worries in the back of your mind when you are a patient. Patients share information that is deeply personal or vitally important to be accurately recorded in the record. The physician or other provider should clearly explain who else is in the room. Sometimes there is a young person who is just ‘shadowing’ to get exposure to possible careers and I think they should be introduced with their level of education and a clear statement that they are ‘shadowing.’ They shouldn’t be scribing. In many professions such a young person observing or helping in the office may be called an “intern,” but this shouldn’t happen in medicine as “intern” means an MD who is in their 1st year of residency training.
There are reasons that it can be difficult for high schoolers to find a shadowing experience, as practices need to be (and should be) circumspect for many reasons. My DD shadowed at an interventional clinic at 15. She needed to do privacy (HIPPA) training, basic CPR training, basic background check and show complete vaccination records (I can’t imagine any practice not requiring.) Office personnel in physician offices are required to have documented HIPAA training in order for the physician to bill.
Beyond HS, young people interested in medicine need to show some realistic knowledge of the profession and many practitioners now employ them as “scribes.” Sometimes to provide an experience for the young person, but also to get the paper work done. They are often paid. Paid scribes is an interesting issue in medicine currently as the higher paid specialties can disproportionately benefit when the lower paid specialties are often the most patient interactive and documentation heavy. (In the original poster’s case it may have been an intern (MD) acting as “scribe” for the physician – a method of work flow.) Another issue is that the training that “scribes” receive varies. There are Center for Medicare and Medicaid Services documentation rules but not training requirements, although many health systems now have scribe training courses. I know it can be very confusing to patients. Don’t be afraid to ASK what someone’s role is in your care!
….And you don’t need to major in a science in undergraduate school at all (History here), just need to take the required science, mathematics, english, psychology and sociology courses.
If a young person is writing notes, those I’ve known were not writing the doctor’s notes for your records. It was their own notes, to later compare with what the doctor’s own, in conversation. Or just to look busy.
If the young person was there not as part of the medical team, but for his own career reasons, he should have been introduced as such, and the doctor should have asked the patient for permission. When I go to the doctor, I’m not volunteering for someone to learn on me. I need to be asked. (See also: vaginal exams on unconscious women without their permission or knowledge, for “training.”)
We don’t have the information to know if his presence was inappropriate (has he received HIPAA training, transcribing training, etc.). But I agree that it would have been appropriate for the doctor to properly introduce him since “intern” in a medical setting means “doctor.”
The last time my D went to her physician, the physician had a medical student doing one of his rotations. The student asked her permission to take her history and symptoms. D gave her permission.
She did say it was uncomfortable as they were of the same age. Almost like a getting to know you date, albeit her medical history date!
I agree that the term “intern” is confusing in a medical context, but disagree with the notion that a person working in a medical office during a gap year is there only for their “own career reasons.” My daughter-in-law also worked as a medical scribe during the year between undergrad and med school – and a scribe performs very important functions. The presence of a scribe frees up the doctor’s time and it improves overall patient record-keeping – so the notion that the person taking notes is only doing it for their own use or to “look busy” would also be mistaken — but then, of course, we don’t know if the person was indeed a scribe if he was introduced as an “intern.” But the OP did say that the person “took medical notes (on the computer) for the dr. – so it sounds like a scribe function. ('the” computer suggests that the notes were being entered on a computer on a desk in the exam room, not a personal device).
Sorry for being unclear. I wasn’t talking about a person who is working as a scribe in a doctor’s office; that person is part of the care team. I was talking about someone who is shadowing a doctor. A doctor-shadower is not doing anything to help the care team; they are instead learning about doctoring. It should be up to me whether I display my body and my symptoms to someone who isn’t there to help treat me.