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Monday, April 5, 2010

Shadowing Basics

I saw a recent discussion about shadowing so I wanted to throw out my two cents. I think shadowing is fantastic. You get exposure to the real work a physician does, and often it isn't glamorous. It's great at giving you a perspective into different specialties, and I almost think it should be required that you should shadow a primary care physician in addition to a specialist.

What I've done as well, is try to shadow physicians at different points in their careers. I have shadowed a specialist who is close to retirement, a mid-career specialist in a different specialty, and a primary care physician a few years removed from completing her residency and becoming board-certified. One of the great benefits of approaching it like this is getting different perspectives. For example, while they all agreed that universal healthcare is a great idea, and healthcare access needs to be improved, they all had different ideas about the healthcare reform passing through Congress, and what kind of an impact any reform would have in the U.S.

My shadowing was all very enjoyable, particularly just to see the rapport that the physicians had developed over time with their patients, where it seemed like two friends meeting and oh-by-the-way let's talk about your blood pressure, or do this quick test and then we can get right back to talking about your kids and how great they're doing. I could almost pinpoint who was a newer patient without knowing any of their history by how open or guarded they were in their discussions with the various physicians I shadowed.

Here are the basics though, in my humble opinion, in seeking out physicians to shadow and how to behave well:
  • For starters, try to contact physicians that you either know by being their patient or have a friend who is a patient of theirs, or a parent who is their patient, and explain your intentions. A great resource here is if you have a good relationship with your PCP, if you have one, and ask them about specialists they frequently refer to, in addition to seeing if you can set up shadowing with them.
  • It's pretty important to set up expectations at the outset when you first make contact and set up the shadowing experience. Let them know your availability and ask if there's anything you should know before the first day.
  • Unless you're shadowing in the OR--which I haven't done, but maybe it's possible from an observation room, I doubt you're going to scrub in for a surgical shadowing experience--you should wear business attire, which for men means slacks and a tie. Maybe throw a shirt on underneath the tie too, unless you look like one of the guys in the Handsome Men's Club. For women, I guess you know what business attire means, probably no open-toed shoes, conservative, hair up/out of your face, etc. That goes for dudes with long hair, too.
  • Keep track of your shadowing hours, I did this when I got home at the end of each shadowing day. I'd write the date, the hours, anything interesting I learned or any interesting patients/cases I saw without many identifying features, i.e. "saw a patient with DM and HTN" not "saw a 67 y/o Caucasian female with Type II DM and HTN who was the divorce lawyer for (insert celebrity here)."
  • Whether you are shadowing in the office or hospital, follow the physician's lead, but don't follow them around like a lost puppy, especially if it seems like they are going to the bathroom. That's just awkward. You can be pretty sure they don't need help making a pee-pee. If they're heading to a patient's room or exam room or to get some coffee, by all means, follow them.
  • If you're uncertain about something, ask a question - just don't do it in front of the patient unless they say it's okay to do so. Example: if you shadow an ophthalmologist and they ask the patient if you can look at their eyes through the slit lamp, and the patient okays it, and they ask you if you see some feature about the patient's eyes, it's okay to ask a question about it if you don't understand what you're looking for. Use discretion though, some are a lot more laid-back about it, and I would say it's probably the physicians that aren't constantly having students come in to shadow them - they usually enjoy the opportunity to teach you something.
  • Make sure you thank the physician at the end - a simple thank you note or card will usually suffice, but also thank the office staff, and any other clinicians that were around, you interacted with, and maybe taught you something.
You can get a lot out of shadowing, and some last bits of advice: stay humble, be grateful you have the opportunity to shadow and stay out of the way. That's pretty important, actually. Ask questions, especially if it's encouraged and it seems like they enjoy teaching you something. In some cases you'll be more of a passive observer and in others you can be more proactive and not just a "fly on the wall." Lastly, here's two thoughts: first, don't be in a rush to leave the office/hospital, even if they say, "We're done, I just have dictations to do" etc., and if they offer you some kind of reading material pertinent to their specialty, take advantage of it - it will make the shadowing make a little more sense even if you have only a rudimentary understanding of what's going on. I had two different docs where one gave me some journals to browse and the other gave me a textbook related to the field and a specific thing to look at since I would see it later in the week. It was useful, and I got more out of the experience that way.

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