Is it wrong for us to tour inpatient psych wards for residency interviews?

[mbgr2014]

I have to say, I have been uncomfortable the way some of the residents take us straight through their inpatient psych wards while all the patients are out mingling, accepting their meds, sometimes screaming obscenities. A resident even took us all the way into an inpatient room (empty at the time but patients out on the floor) unnecessarily while a patient could have grabbed an interviewee by the tie or charged from behind. The general walking through the ward has happened on more than 1 interview so I assume it must be normal, but is it right?

Don't get me wrong, I have done a whole month of inpatient psych with some agitated patients so it's not that I'm just afraid of them. I've gotten used to having my guard up to a certain extent. But it seems a little unethical and unnecessary to show us the floors. If they do that why not at least have all the patients be out in one of the recreation areas, and you can get some honest commentary from nurses about what life is like on the ward?

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[WaterIsGood]

You feel uncomfortable with us showing you what your potential work environment looks and feels like?

 

[wolfvgang22]

I get it, it can be a bit uncomfortable being in a strange place with strange people and strange patients. It is for me, too. But I would rather be a bit uncomfortable and see what it is *really* like on a typical day, not what somebody wants me to see. Especially if I'm going to be committed to the place for 4 years.

 

[Candidate2017]

But it seems a little unethical and unnecessary to show us the floors.

As others have said it's necessary to see what you're getting yourself into (patient population, severity, security, staff, facilities). Second, it's 100% ethical and appropriate to take an interviewing medical student to an active psych ward. You are not a tourist or visitor to a zoo. It may not have been fully apparent in the past 4 years while hitting the books or playing pretend doctor on clerkships, but you are a member of a profession with the privilege of being around patients during their most vulnerable or uncensored times, and the people allowing you on these tours fully expect you uphold professional standards. You have to be comfortable with that.

 

[Stagg737]

If they do that why not at least have all the patients be out in one of the recreation areas, and you can get some honest commentary from nurses about what life is like on the ward?

What is less ethical towards the patients:

Having prospective residents/employees tour the ward and allowing the patients to mingle as they please.

OR

Having prospective residents/employees tour the ward and telling the patients they're only allowed in X area for the next Y amount of time because future doctors will be using the facilities.


If I'm getting what you're trying to say, it sounds like you're concerned with patients' rights to privacy, which is a valid concern. However, future employees also have the right to see where they'll work. Additionally, the latter option (which you proposed) essentially conveys the idea that the doctors are more important than the patients, which I think is the more unethical option.

Keep in mind not every facility has a large recreational area where patients can go, nor are they set up where they can tell all patients to hang out in one area without inconveniencing all of them. I toured a facility with 120+ beds. Where are those patients supposed to go while we tour? Especially since the only rec area that could fit them is outside and my interview was in November when it was 20 degrees outside. So while I understand your concern, I don't think it is as much of an issue as you think it is. Additionally, as Candidate pointed out, you are expected to have a level of professionalism and respect so that these patients' privacy rights are not violated. If one cannot uphold those standards, that person doesn't belong in medicine at all.

 

[mbgr2014]

Points all well taken. I think my concern is mostly for the patients' privacy, but I agree with everyone else that by the time of clinicals/residency interviews we are already used to a very high ethical standard. I think with this reframing I'll be more comfortable the next time.

I just didn't have anyone in my personal life who I felt comfortable expressing this. Thanks for helping me work through it SDN

 

[deleted480308]

If the concern is privacy you are all ms4 or higher and should have signed a hippa acknowledgment prior to tour

If the concern is applicant safety (you mentioned wearing a tie) all applicants should be warned about appropriate attire while in that ward (no tie or earings are often the main ones) and not expected to change during the day

 

[whopper]

If I were an applicant I'd want to see the inpatient unit.

Some inpt units are dungeons, others are more modern, safer (e.g. better lit, have touch-button alarm for employee that they wear, etc).

If anything I'd be more suspicious of a program that didn't want you to see their inpatient unit.

 

[MedMan80]

I would be concerned if a program wasn't showing applicants the facilities, as it could be an indication of them trying to hide something..as mentioned above, you're a physician touring a place of employment..

 

[Mad Jack]

I have to say, I have been uncomfortable the way some of the residents take us straight through their inpatient psych wards while all the patients are out mingling, accepting their meds, sometimes screaming obscenities. A resident even took us all the way into an inpatient room (empty at the time but patients out on the floor) unnecessarily while a patient could have grabbed an interviewee by the tie or charged from behind. The general walking through the ward has happened on more than 1 interview so I assume it must be normal, but is it right?

Don't get me wrong, I have done a whole month of inpatient psych with some agitated patients so it's not that I'm just afraid of them. I've gotten used to having my guard up to a certain extent. But it seems a little unethical and unnecessary to show us the floors. If they do that why not at least have all the patients be out in one of the recreation areas, and you can get some honest commentary from nurses about what life is like on the ward?

It is extremely necessary to see the inpatient unit, as you will spend a minimum of a year there so it is critical to understand what resources and amenities these units provide for your patients. You sign HIPPA papers before your interviews, you never interact with the patients themselves, and you are being led through the ward to make an informed decision in your residency ranking process. There is nothing immoral or unethical about it.

If acutely psychotic and potentially dangerous patients scare you, let me tell you that you have chosen the wrong field, as many of those same patients are going to present to you in your office where it is just you and them with minimal to no security. Psychiatry is statistically the most dangerous of all medical fields for this reason, with only EM coming close but all other specialties being left far in the dust. You will have people threaten to kill you. You will have patients assault staff (potentially yourself) on the unit. If you aren't in a large metro, you will often be discharging these people into your own community where they will be within walking distance of you and your family. None of that bothers me, it goes along with the job. But if it bothers you, well... Get ready to be paranoid for the rest of your life.

 

[mbgr2014]

I will say that I haven't been asked to sign a single HIPAA form for interviews and I've been on four interviews. I respectfully wonder if my experience is unique or if other applicants are also not being asked to sign any privacy paperwork... That being said, I agree that anyone who can't handle HIPAA-level privacy on interview day won't be a good fit as a physician in a few months.

Luckily I've already had a month of inpatient psychiatry in the sort of wards being described, and feel more comfortable having had that experience than I would have on interview day going in blind.

 

[WisNeuro]

I will say that I haven't been asked to sign a single HIPAA form for interviews and I've been on four interviews. I respectfully wonder if my experience is unique or if other applicants are also not being asked to sign any privacy paperwork... That being said, I agree that anyone who can't handle HIPAA-level privacy on interview day won't be a good fit as a physician in a few months.

Luckily I've already had a month of inpatient psychiatry in the sort of wards being described, and feel more comfortable having had that experience than I would have on interview day going in blind.

It is not unique. Throughout all of my internship, postdoc, and faculty interviews (all at locations with inpatient units, most of which I toured) I was never asked to sign a HIPAA document, this is for any type of setting (VA, non-profit hospital, university affiliated hospital).

 

[clausewitz2]

It is extremely necessary to see the inpatient unit, as you will spend a minimum of a year there so it is critical to understand what resources and amenities these units provide for your patients. You sign HIPPA papers before your interviews, you never interact with the patients themselves, and you are being led through the ward to make an informed decision in your residency ranking process. There is nothing immoral or unethical about it.

If acutely psychotic and potentially dangerous patients scare you, let me tell you that you have chosen the wrong field, as many of those same patients are going to present to you in your office where it is just you and them with minimal to no security. Psychiatry is statistically the most dangerous of all medical fields for this reason, with only EM coming close but all other specialties being left far in the dust. You will have people threaten to kill you. You will have patients assault staff (potentially yourself) on the unit. If you aren't in a large metro, you will often be discharging these people into your own community where they will be within walking distance of you and your family. None of that bothers me, it goes along with the job. But if it bothers you, well... Get ready to be paranoid for the rest of your life.

I mean, you can avoid ever dealing with these folks again by becoming one of those people who decide they are super interested in women's mental health because it is a good way to have a private practice where you only see bourgie white ladies all day. Those pesky four years before you can bail, though...

(I am in no way knocking the people who come to women's mental health bwcbeca of interest in trauma, reproductive psychiatry, etc, you know who I am talking about though)

 

[whopper]

Mentioned this before in other threads but adding to what I wrote in this thread....
Some psych units are pretty much dungeons. Some literally have the old neck clamps still on the walls. Yeah they don't use them anymore but that's how old, dingy, and disgusting these units are.

So heck yeah you should check out the unit cause you likely don't want to go to a program whose psych unit looks terrible. If it looks terrible there's likely a hell of a lot more problems going on other than the physical aesthetics of the unit.