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Do Not Shadow [DNS] provides patients a respectful environment

imageAs a university professor,  I actively promote effective teaching methodologies.   But a recent multi-month stroke recovery through various medical facilities, where physicians, nurses, and therapists would ask if I minded students “tagging along” during their rounds has given me pause. For the most part, I assented without hesitation. Hands-on teaching and training represent an efficient and effective transfer of medical knowledge between generations of medical practitioners. But . . . for the sake of patient privacy and personal respect, should persons with certain mental illnesses and brain injuries be placed on an automatic, paternalistic “Do not Shadow” [DNS] List as opposed to a default, informed consent alternative? For instance, maintaining personal hygiene is an integral component of medical practice, but repeated bathing and toileting for training purposes seems superfluous and can diminish an authoritative/professional relationship between observed and observer. This issue first surfaced when a former student of mine accompanied my OT shower. I did not mind her observing my other therapeutic activities, like playing chess or testing limits of my visual field, but the public bath left me later feeling vulnerable, exposed, and slightly embarrassed. I don’t blame the rehabilitation facility as they did request my general consent. What wasn’t caught was that I previously was a professor at the same school as this prospective intern. The specific academic connection would have been difficult for anyone to catch as the student no longer attended the same university.

Reasons against forming and conforming to a “Do Not Shadow” [DNS] list for training purposes are manifold:  Shouldn’t informed consent be sufficient for patient autonomy and enough to preserve privacy? What brain injuries would we leave on and off such a list? And is the latter unnecessarily burdensome and inefficient? Shall mentoring/teaching value or individualrights take priority? Or  respect ultimately a relatively trivial matter compared to excellent training and efficient care?

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