Physicians who are medical school faculty without private practices must balance the realities of their practices against patients’ right to choose who delivers their medical care. This dilemma is exacerbated when the teaching program has assumed the obligation to care for classes of patients other than those who voluntarily choose to be treated at a teaching facility: emergency patients, indigent patients (when the teaching program has charge of an indigent care program), and patients with a contractual right to be treated, such as members of a managed care plan for which the medical school has contracted to provide care. Persons in these classes retain their right to refuse the care of students and residents.

Faculty physicians should obtain their patients’ permission to be included in the teaching program in the same way that a private physician would. Except in emergencies when consent is not required, this permission should be obtained before the patient is seen by students or residents. In teaching programs with insufficient attending staff supervision that rely on students or residents for primary patient contact, the first person to see the patient should obtain the patient’s consent. To lessen the implicit coercion in such a situation, the patients should be told that they have a right to refuse care from a resident or a medical student. Most patients consent to be treated by students and residents; the teaching program and the nursing personnel must respect the wishes of patients who refuse this care. The patient’s right of privacy should not be violated for the convenience of the teaching staff.