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The Physician-Student Relationship

The duty to teach students is sometimes contractual but usually only an ethical obligation. Faculty members who receive a salary for teaching must educate the students under their supervision. Physicians who accept staff privileges at a teaching hospital also may have a contractual duty to teach. If teaching is a requirement for staff membership, accepting the staff privileges means accepting the teaching responsibility. For most physicians, there is no formal contract that requires teaching, but there is an ethical duty to improve the practice of medicine and to educate new physicians. If the physician derives any benefit from the presence of students, this ethical duty becomes very strong.

In theory, a student should not be allowed to do anything to a patient that the supervising physician cannot legally authorize a layperson to do. The physician should verify everything the student does. For instance, if a medical student does a history and physical examination and dictates the findings, the physician must repeat the history and physical to determine their accuracy before signing the dictation. Otherwise, the physician would be illegally delegating the practice of medicine to the student.

If the person doing the history and physical is a resident in a teaching hospital, it may not be necessary for the attending physician to repeat all the work. The resident may have a limited license to practice medicine through his or her training institution. It is important to know the legal status of the student or resident. A student doing an intern-like rotation is still a student and may not do any medical practice. A resident who has no independent license is restricted to practicing within the limitations of whatever institutional license he or she may have. Even an independently licensed resident physician may be limited in the scope of practice by the residency policies. These may not carry the force of law, but they may affect malpractice insurance coverage.

Whether a physician has the right to refuse to treat a patient who will not participate in a teaching program depends on the circumstances of the physician's practice and the laws in that jurisdiction. A private practicing physician who chooses to act as a preceptor has the right to turn away patients who object to this, if the proper steps are taken to provide the patient with alternative care. Otherwise this might constitute abandonment. If the patient is entitled to care from the physician because of contractual arrangements, such as an HMO or because of emergency care laws, the physician does not have the right to force the patient to accept care from a student.

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