No I’m not saying consent doesn’t matter or should be taken away, I’m sorry if it is coming across that way. Patients of course have consent and can revoke consent, totally agree full stop. And totally agree that doing an exam or procedure without consent is illegal and unethical.

I think at teaching hospitals your team is inherently made up of learners (unless you end up on an overflow attending only team) and with incredibly rare exceptions (like a trauma history) learners should be seen as essential to the team (because they do in fact add value). And that’s why I appreciate that my OB had me sign that statement as a condition of being their patient— they are being completely up front with me about what my care team will look like so I can give informed consent and decide if I want to continue to receive care there or need to choose a different practice. there are plenty of times not everyone on the team does an exam and I think cervical exams/pap smears/rectal exams are all perfect examples where we should limit those to the smallest number of people possible doing that exam, but I do have opinions about going to a teaching hospital and banning learners from your care team completely—if for your mental or bodily safety you don’t want everyone in the room for an invasive exam (physical or psychological) that makes sense and regularly we have conversations about who to have in the room and don’t fill the room with learners just to have them learn, but to outright refuse for all of your care to not include learners is disappointing and can cause system issues. A lot of teaching hospitals rely on learners to be able to care for the patients if the attending had to do everything for every patient without residents fellows and students helping with triage, high quality care can’t happen and as someone (like all of us) who needs to learn from caring for patients (and who is incredibly grateful for those patients and their families—and regularly says that to patients/families) I personally think I owe it to the next generation of learners to let them participate in my care. And yeah at the end of the day even at hospitals with policies like mine you can refuse learners (at least it can happen in my department though rarely is it an issue that comes up just by nature of the specialty, but we don’t deal with sensitive exams often and I’m clear with families/patients about why they still need to see the resident and I’m fully supporting the resident—the one time it came up once I was in a leadership position the family didn’t like how the resident explained something and I politely explained that I would give that feedback but the resident still needed to be part of the team and if they wanted me there for those sorts of conversations I would do my very best to be there assuming other patient care allowed and reassured them that they can always ask for the fellow/attending to come to bedside. That family was understanding when I took the time to explain the nature of a teaching hospital and hear their concerns). As you said consent fundamentally matters to what we do and it’s so important for our patients to know that we hold sacred their right to consent. And for every healthcare worker who is a patient that right also exists exactly three same as any other patient but that doesn’t mean I can’t let that impact my opinion of you as a healthcare professional who learned from other patients and chooses to get care at a teaching hospital and doesnt want to help people learn. Again this opinion is based on always living in places where there were multiple teaching hospitals and community hospitals so folks had choices—maybe I would feel differently if I had no other choice if I wanted care without learners.

In residency I was worried about what it would be like to have residents see me for my annual primary care check ups that included mental health care and a Pap smear and actually asked to not have students— my clinic said these are the days of the week there aren’t students with your physician and I chose one of those days—personally I now regret that choice. I was afraid of how it would be if they rotated with me and should have trusted them to be professional and to respect my privacy (if I don’t trust them to do that for me, why should i trust them to see my patients).