Yeah, I'm not afraid to say "no," but I accept, especially in a therapy situation, some would be and shouldn't be put in that position. But observation is a core part of US medical training. If you live in an area where all the available hospitals are teaching hospitals, it is a common practice. You can theoretically decline, but the system is by default set up to make that a more difficult choice. It's a bit like subscription services in which the default is to automatically renew, rather than re-subscribe; you can cancel, but you have to make an affirmative choice to decline. I do think it should be the other way around in all these situations. But there is also an element of public good in these situations in which we all have a stake in the future sustainability of well-trained professionals. So I pick and choose: if it's a low risk circumstance with minor risk to my privacy and comfort, I agree; if the nature of the procedure is high risk, I decline.

I had a minor surgery not long ago and was presented with a med student observer; the policy at my hospital is to whenever possible, default to single gender OR teams for female patients. So the anesthesiologist, nurse, tech, and observer were all female; the surgeon was male. I felt that was a good compromise, whereas a surgery I had at a surgical center had no such policy, and I found out later that the entire OR team was male. It made me uncomfortable, and if I ever have to return there, I will be pro-active to alter that circumstance.