Mayo Clinic Rochester Michael Sarr MD physicians seeking care at the Mayo Clinic can't be cared for by students, residents & interns - don't come for 'easy' diagnoses - expect the same courtesies of care (can't make their own diagnoses & Rochester, Minnesota

This is for Warner Andrew Oldenburg MD about physicians caring for physicians, colleagues, classmates.  In Medical School - which I couldn't discuss with him because he got married and never was around after that - I got into 'big' trouble for refusing to work up a classmate to present him on Medicine Rounds.  And, I asked, but J. refused and gave me the reasons, reasons which the attending did not understand, but which I did.  So I flunked those 3 weeks on Medicine [which Dr. Oldenburg will get a 'kick' out of] simply because of this disagreement about a classmate's right to privacy, but I still got my Internal Medicine Boards on the first try. 

In the present of 2012, I expect that medical students, interns and residents do not try to do care on an MD patient if that MD patient so requests, because, when you get to that point - you might request that same courtesy - not wanting your medical information in public domain when you seek any medical care - and it happens.  Things suddenly show up on Facebook with pictures.  Physicians don't present with easy cases, or they wouldn't present.  My MD father told me of his appendectomy as an intern at University Hospitals - he was awake and the fellow intern's comments, about his appendix size & other things, almost had him off the table.  My father doesn't have a photographic memory, but he can repeat every word to this day.   

Physicians, from your Medical School class, or physicians from anywhere, come to Mayo Clinic for second opinions and 'quiet' care - so that details of an illness are not in their practice communities, so that their blood work and test results aren't all over the hospitals in town.  So that they can get a diagnosis or health check without being taken advantage of - not for TEACHING PURPOSES, or multiple student breast EUA, intubation practice, pelvic exam practice, or other resident experiences.  Physicians know too much about the process, and what can go wrong during these 'practices.' 

Caring for a physician patient - who has a body of knowledge - tests physician skills in a different way, and often physician-patients turn out to have 'zebras,' or uncommon presentations of the very common things - which confuses everyone.  Rule #1 is never to take a physician's case at face-value; an abdominal swelling is never a retained prolene suture or neuroma.  Taking everything off for an unnecessary procedure as a physician-patient, because the attending didn't do the Carnett's test - is pathologic, cruel, misogynistic, immature, and 'boys being boys' - like an airport strip-search.    

The Washington Hospital Center Physician published an article with guidelines for caring for a physician-patient in January 2003: (1) apply the same standards of care; (2) remain objective, (3) involve physician-patients in decision-making, (4) arrange consultations with other specialists for second opinions, and (5) be supportive as physician-patients are as scared, or more, than average patients.       

Resident first experiences - the do one - should not be on physician-patients.  And mistakes done in those contexts need to be repaired at Mayo Clinic expense - by the attending.  Medical students, surgical interns & residents can't diagnose abdominal pain well, or at all.  And they can't cut, sew even common mass closures, close incisions without dog-ears, or sometimes even stand up in the OR - they are employees, but physicians-in-training. 

Medical students, interns & residents are not to be doing the medical care for MDs, DOs, their Medical School classmates, or their Residency/Fellowship job competition.  This is unethical.  This is to protect all from unnecessary suits, malpractice filings, negligence because of distractions, Medical Board complaints, conflicts of interest & bias.  For instance, I wouldn't pretend to ever care for Warner Oldenburg's wife - that would be uncomfortable.  And if a medical student, intern or resident has a pressing desire to be 'in' on a case, they need to obtain the permission of the physician-patient.  'Ask and you shall receive' or get another veto, but learned how to communicate.         

Physicians come to Mayo Clinic for expert care by experts - not to be teaching cases - not to have to file Medical Board complaints about receiving care that they never consented to by an intern that didn't have the experience for the case.  3-month surgical interns should be taking a crash course in Surgical Technology - so that they know that the instrument set was sterilized, the suture types & where the packets are kept for set-ups, how the blade is applied on the scalpel, etc.  They still don't know which OR to show up in let alone the instruments, the steps of the procedure, or the diagnosis of the case - they are learning & not experts.  They should not be doing the case, the incision or the closure - that's why they have a Mayo scissors.  Attendings should dictate the OR reports on physician-patients, having multiple 'revisions' on a physician-patient is not a good thing.   

Physicians expect that a physician, not student MD, will speak to them to take a history, physical & order the appropriate tests - not do a 'fudge job' and start reminiscing about the 'glories of Mayo Clinic.'  Physicians expect that the day of the procedure, the surgeon will speak to them, or their family member getting the surgery or procedure - not be drinking coffee, gossiping, or coming off last night's dinner party drinks. 

No one should be drinking before procedures - that means the Chief of Surgery, the Vascular Surgeons, the students, interns & residents.  Nothing is more disturbing than to hear that the physician, or surgeon, was at a dinner party last night - because everyone drinks at those parties.  Surgeons need to be in an alcohol-free zone to care for a physician-patient because we have all seen physicians try to work, or call in, after too much to drink - when they should have excused themselves.    

It's an insult to have to keep saying, 'No residents, no interns, no students.'  Physicians are not teaching cases, and neither are their families - because you can then write a horrible recommendation for a 3-month intern, first day on the clerkship medical student, or even the Fellow new on service.  And informed consent applies for physicians - you don't suddenly decide to remove a swollen nerve without the proper scan, intraoperative ultrasound, blood work, consultation, and the 2% injection to diagnose & treat anterior cutaneous nerve entrapment.  The physician will not understand.

When care is provided by students, interns & residents who haven't got the experience of even the physicians that the physician has consulted at home - things get unreliable.  Physician-patients have to depend that their physicians are reliable.  Professional courtesy to physicians HAS TO INCLUDE that Mayo Clinic attending staff provide the physician's care. 

No physician comes to Mayo Clinic for the medical students, interns, or resident staff - and having to walk out of consultations, or have multiple redos of simple procedures, fracture care, or surgeries, is not ok.  No physician can afford this, and it's not proper to have care from someone with less clinical experience than the physician seeking care at Mayo - that should be the litmus test as to who gets into the exam room.  And visiting MDs do not belong in MD cases - no one wants to share their care with the world.

Warner Andy Oldenburg MD - your classmates from Medical School expect that when we seek consultation at Mayo Clinic we will get the real 'deal,' not be misdiagnosed so that someone can get a surgery to fill a suddenly 'open' OR slot without the proper scans or consultations, and that there will be follow up exams and the proper blood work before any procedure or guessed diagnosis.  Not everything that looks 'neuroma,' is 'neuroma.'  And you don't operate on neuromas. 

Physicians can't do all the care for themselves - and would like to close their own incisions, but a medical student with no experience is a nightmare - and you know this.  And if we didn't have to have that procedure in the first place, because the Chief didn't read his copy of Surgery, or his 2011 issue of The Mayo Clinic Proceedings, we might never speak to you again.  Health is too precious to waste a minute of it with someone who isn't reliable.