Richard F. Mitchell, MD, MS
“Did you discuss prostate cancer screening with your patient?”
“I did, but…”
“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”
Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”
You might find the answer in an invisible bag.
“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”
“Why would I do that?”
“It’s full of $100,000 bills.”
“Yes! Can I take two?”
“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”
“That’s OK—can I put my hand in now?”
“One last bit of information before you do—it’s also full of razor blades.”
Dennis Baker, PhD
In 2001, I took a position as the assistant dean for faculty development at the newly formed Florida State University College of Medicine (FSUCOM) in Tallahassee. I came to FSUCOM with 22 years of faculty development experience, the bulk of that with the Ohio University College of Osteopathic Medicine.
For 16 years I travelled throughout Ohio giving teaching skills workshops for community preceptors. It was during the late 1980s through the 1990s, when the landscape of medicine was changing and preceptors had less time to teach and to participate in faculty development activities. I often thought about pushing for a faculty development requirement but knew there would be push back from preceptors and the administration.
Keith Foster, PhD
Advances in technology have made direct observation by video recording or live-feed easy and affordable, allowing the most financially limited programs to conduct direct observation this way. It is not surprising, then, that a large number of family medicine residency programs use some form of video recording or live-feed direct observation.
What is surprising is the absence of or only passing reference to the issues of informed consent, patient authorization, and procedural guidelines related to video recording and live-feed precepting in the examining room, particularly in the age of HIPAA.