Six Things Medical Students and Trainees Should Question

11:43:00 PM

Doc Iris shared this to me through Twitter. I wrote this blogpost because I feel that a lot of medical students should know these pearls. Learning this will not only make medical students better doctors in the future but it will also save lives and money of their future patients. This list was adapted from the journal article "Choosing Wisely for Medical Education: Six Things Medical Students and Trainees Should Question" by Lakhani et al. (2016). 

As early as now, while we are still medical students, we must learn how to avoid overtreating our future patients and subjecting them to unnecessary and wasteful medical procedures.

1. Dont suggest ordering the most invasive test or treatment before considering other less invasive options

According to a journal article published in JAMA surgery, a lot of patients undergoing medical procedures are not always informed about the less invasive options that could eliminate health risks and huge amount of expenses. Let us always inform our patients of all treatment options including the less invasive and less expensive ones.

2. Don't suggest a test, treatment, or procedure that will not change the patient's clinical course

Overtreating patients is very rampant in the medical community. A lot of medical procedures done in the past years were determined to have no benefit or to be outright harmful for the patients. The increasing number of useless tests and treatments conducted to patients is extremely alarming. These unnecessary medical care is not just harming the patients physically but also financially.

Millions of people are taking drugs that are not helping them at all. We must always remember that all drugs have side effects and these patients suffer from the side effects without getting any benefits from the drug. A lot of people undergoing operations that are not beneficial for their health and a lot of diagnostics tests that will not help the doctor make a better diagnosis of the patient. These things perpetuate in the medical practice because of the idea of "defensive medicine". It is better to exhaust all test or treatment available rather than suffer the consequences of negligence for missing a warning sign in the patient.

3. Don't miss the opportunity to initiate conversations with patients about whether a test, treatment or procedure is necessary.

As future medical practitioners, we should always instill in our minds that our patients should be well informed about potential risks of their test or treatment. I think even the costs of the test and treatment should also be disclosed to the family. Let us not deprive them of information about treatment options. They should be part of making medical decisions. Let us encourage our patients to ask questions and clarifications on the medical procedures that he/she will undergo. 

4. Don't hesitate to ask for clarification on tests, treatments, or procedures that you believe are unnecessary.

Let us avoid blind obedience. Of course, we should respect and obey authority since it is part of the rules of society, and this applies in the field of medicine. But it is never wrong to ask questions and clarifications from our seniors. If we believe that some procedures are unnecessary for our patients, try to talk to your seniors and ask them the basis and reason why such medical procedure should be done on your patients. Healthcare providers have to deal with the new realities of healthcare practice. In collaborative practice, team members have the right to speak up and ask questions. If we don't do this, blind obedience will still continue to be a source of medical error

In the same breath, we should inform our patients that they have the right to question all the test and treatment that they will undergo. They can ask the reason for such test and treatment.

5. Don't suggest ordering tests of performing procedures for the sole purpose of gaining personal clinical experience.

We learn from our patients. They are very great teachers. They let us perform medical procedures on them so that we can become a better doctor in the future. They teach us things we probably don't learn in the four walls of our classrooms. 

But we should not risk their life for the sake of getting personal experience. Remember that they are not lab rats that we can subject to any procedure and experimental treatment. They are human beings with feelings and dignity and they deserve our respect.

6. Dont suggest ordering tests or treatments preemptively for the sole purpose of anticipating what your supervisor would want.

Always consult supervisors and consultants before ordering a medical procedures. Although we already have a knowledge in different diagnostic procedures and managing patients, we should still consult our consultants (they're not consultants for nothing). The consultants are responsible or all medical services provided by the medical students and trainees so we should always consult them before ordering medical procedures.

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