Is this common with teaching hospitals?

[liketheairport]

This was several years ago, so bear with me while I remember some details.

I had been admitted to one of the larger hospitals in my area. I was in DKA, recently found out I was pregnant, and was basically just waiting to get my blood glucose down. So, there I am, feeling crappy anyway, when a teaching doctor comes in with a bunch of residents without asking and tells them about my conditions. He then proceeds to ask me about another condition, which has nothing to do with the diabetes or the fact that I was pregnant.

I have mild excess facial hair, something a lot of women do. Normally, if I am at home, I groom it away and generally no one knows about it. This doctor pointed it out, asked me "has it been like that since puberty?", and then talked about me as if I wasn't there.

Is this standard practice at a teaching hospital? It made me very uncomfortable, and as a potential nursing student, I would hate for any patient to feel weird or like a sideshow. This was not my doctor. These were not people I knew. It wasn't the nurses who had been taking care of me a couple of days now. I, as a patient, was already feeling pretty crappy to begin with. This certainly didn't help me rest better or add to my getting better. What should I have done?

[MunoRN, RN]

It's usually poor form to give someone the impression that they have a choice about something when they actually don't. I have a feeling you'd be even more upset if they asked for your permission, just to be polite, and then told you that you didn't really have an option if you declined.

[liketheairport]

Then tell me I have no choice or let me know you're coming in. Don't just walk into someone's room, not introduce yourself, and then get snippy when I'm not precisely as cheerful as you'd like. I wasn't rude about it, I answered his questions politely. I'm sorry he had to teach these people if he sincerely didn't want to and I'm sorry he has long days and nights, but...

I do understand that they're learning while in a hospital environment. I'm not trying to sound whiny, I just think that any patient who is able to understand is TOLD that residents will be learning on the floor today, that's all.

[KelRN215, BSN, RN]

At a teaching hospital you are cared for by whatever services, or medical specialties, you need. And yes, it is a team approach. It may have been the first time you encountered that attending and physician residents in person during your stay, but they were consulted by whatever primary service you were admitted to, and so were legitimately involved in your care from the outset.

And while I am not asking for any further details on your medical history or your reason for that hospitalization ... it does occur to me that your primary problem at that time was a complication of an endocrine disorder ... and excess facial hair in women can be indicative of endocrine issues. I'm guessing that that *endocrinologist* was putting together the larger picture of your medical condition, beyond "waiting to get your blood sugar down".

BTW ... residents are licensed physicians with prescriptive authority, and outside of certain specialties and subspecialties they provide the bulk of day to day physician care in teaching hospitals, under the supervision of attendings.

Good luck with your nursing studies.

I had the same thought about the endocrine connection.

[MunoRN, RN]

Then tell me I have no choice or let me know you're coming in. Don't just walk into someone's room, not introduce yourself, and then get snippy when I'm not precisely as cheerful as you'd like. I wasn't rude about it, I answered his questions politely. I'm sorry he had to teach these people if he sincerely didn't want to and I'm sorry he has long days and nights, but...

I do understand that they're learning while in a hospital environment. I'm not trying to sound whiny, I just think that any patient who is able to understand is TOLD that residents will be learning on the floor today, that's all.

I would agree that we, as Nurses, could do a better job of letting patients know what to expect, which is basically that you are a potential object of learning 24/7.

The cognitive characteristics that often draw people to medicine and are conducive to learning medicine often also include poor social skills. Not all Physicians fit this description, but a relatively large portion does, and to some degree it's not an issue of not caring about how their behavior makes you feel, it's an issue of not being able to comprehend it, which means it important for both sides to show some empathy.

[DoeRN]

I worked at a top 10 teaching hospital for a very long time and this is pretty standard as far as groups of doctors rounding on patients. But from my experience the doctors did introduce themselves. Like "hello I'm Dr. Smith with cardiology," and then proceeded to present the patient to the group that's rounding. What I noticed was a lot of the doctors there made it a point to address the patient by name and asked if they had any questions.

I'm in a different state now and work at large teaching (not a top 10) hospital that sounds more like what you experienced. Needless to say I miss my old hospital and should have never left. The doctors at this hospital basically ignore the patient, talk real fast, and leave.

But yes this is standard at a teaching hospital. Some do it differently than others. I actually prefer to work at be treated as a patient at teaching versus private/community hospitals.

Sent from my iPhone using allnurses.com

[LadyFree28, BSN, LPN, RN]

Hmm...I see both sides of the coin.

The teaching hospitals I worked for or rotated during my studiesASK before coming in; few times there were rude interns; I've had patients kick them out, for a good reason; the patient I remember most was a schizoaffective woman whose had a complex history; her triggers were people raising their VOUCE and touching her on the shoulder; the resident was notified of her triggers; when the pt asked pretty valid questions, the resident decided to raise her voice...my pt deserved a Medal of Honor for handling that well in her acute state.

As a trauma pt 5 years ago, the Trauma team watched me transfer successfully without any help...it was about 8 or so...I was heavily medicated so who knows? I know I had an audience. I had the chief trauma surgeon and the residents and interns watch me get out of the bed into a chair in an ICU. I don't remember applause, but the look on their faces was priceless. :)

I remember waking up and they just finished with my abdominal dressing, and said "we just finished with your dressing!" I didn't think it was rude, I was actually relieved, lol.

It was weird to be constantly monitored rounded on....I liked the team, and they were generally very respectful but the med students were my buddies; they were willing to help out when I forgot something; I actually had one get me fresh ice because I knew the nurses were doing change of shift report, and they loved coming in with the resident at that time: It's was a fair trade...teach one, as they say ...in a good way.

OP, one of the things I have realized when I was a pt while being a nurse was how I wanted people to treat me how I treated my patients; some needed enlightenment, most were excellent; I think the positive part in being vulnerable as a pt was that I became even more acutely aware of giving holistic care, and a certain nursing mindfulness in approaching my patients. You will have that mindfulness when you enter the clinical setting; I am sure you will be able to put it together successful as a student nurse. :)

[Art_Vandelay]

I'm OK with being used as an example. I just would have appreciated being asked about it. I would have appreciated the MD treating me like a person rather than some visual or teaching aid. Honestly, I knew why they were asking and that they were trying to teach the residents, but six people in my room, not introducing themselves or telling me what specifically they're teaching is rude.

I'm sorry this happened to you. I agree, the behavior is rude. I chose a teaching hospital for my first baby, because it is considered "the best". That being said, after a first year resident couldn't place an internal monitor or identify the baby's head placement on the ultrasound, I requested a different doctor(a fourth year). Fortunately, they didn't act rude at my bedside...as far as I can recollect.

Just because it's a teaching hospital doesn't excuse poor bedside manner. I think this is lacking more and more...teaching hospital or not.

[notsureabout1]

I might get flamed here. . .but I will add in my opinion for what it is worth. I am not trying to offend anyone here, just being honest. I was in a teaching hospital a few years ago. It was a top 10 biggie. Aside from the total lack of any privacy and dignity and being talked down to and treated like I was an idiot, it was also a horrible experience. I believed all the "hype" about how it was "THE BEST!!". I feel like that's all it was. . .hype. I was treated terribly, had a medication error, surgical error and to top if off I got a nice hospital acquired infection as a souvenir. The nurses were totally overworked and the resident was very inexperienced. I really do not understand how people can say teaching hospitals provide better care where when by all admissions a large part of the care is provided by residents who are less experienced. It just seemed to me like it was very disorganized. I think they were getting by on their reputation. I have since been hospitalized at a private hospital and it was completely different. And not different in the customer satisfaction survey, oh the nurses were "nice" and the food was good way, [although both were true]. It was better in the "I am really glad I did not get an infection" and "I am glad they did not give me a medication I told them I was allergic to that made me break out in hives way" and especially the "gee I am really glad the resident who worked on me did not botch the procedure like the last guy way". So, like I said, you will probably all flame me and that is fine, but I think teaching hospitals are sometimes more hype than reality.

[Altra, BSN, RN]

I do understand that they're learning while in a hospital environment. I'm not trying to sound whiny, I just think that any patient who is able to understand is TOLD that residents will be learning on the floor today, that's all.

I think you have some misconceptions about care in a teaching hospital, and that's understandable, as you are not yet a nurse and this may have been the first time you were admitted to this particular hospital.

In your posts you have spoken of the residents in terms such as "learning on the floor that day" ... when in actuality they are licensed physicians who are providing your care, writing your orders and likely performing your procedures.

Rounding, or "checking on" hospitalized patients, is done by all physicians. In a teaching hospital it is usually a group format, and yes, it can seem like a herd of people. But they are not uninvited guests at your party ... they are the ones providing the care that you / your insurance is paying for.

Maybe the attending physician was abrupt. Ok. But from what you've presented in your posts, I don't see anything out of the ordinary. You were admitted for an endocrine problem. Another s/s of a possible endocrine disorder was discussed among the team taking care of you. It may be one that you are sensitive about ... but the discussion was about pathophysiology and treatment ... not to make you feel uncomfortable.

I hope this gives you a better understanding of hospital care.

[RetRN77]

So at the cost of dehumanizing patients? Just because it is a teaching facility does not mean bedside manner has to be left at the door. The stories the PPs told are pretty sad, and it's a shame that's the standard.

I have to say that frosts me. There is just no reason for that. I trained at teaching hospitals and I worked at teaching hospitals almost exclusively. I saw a couple of rather borderline "specimen" visits, but nothing like described by the first two posters. Usually they were at least perfunctorily polite, stating their purpose and attempting to be somewhat civil, and most times they were more than civil. I don't remember them just swooping in and out as if they were visiting a zoo exhibit. Generally, they were conversing about how to treat the patient, not just there incidentally because there was something someone found would make a teaching exercise.

Unfortunately, when my son was hospitalized in a coma post TBI, we were the recipients of just such an unannounced "visit." They were somewhat polite, but they had this curious avidity about themselves that gave me the chills. Suddenly, the senior resident mentioned my son might have Prader-Willi Syndrome and everyone hummed excitedly, giving various other possible diagnoses. I couldn't believe my ears. My son was in a coma, having unrelenting seizures, no one knew if he would recover or not, and these inconsiderate juveniles were visibly getting all excited over the possibility of having discovered a patient with a possibly rare, but completely unrelated syndrome. In addition, they didn't even have the finesse nor consideration to have a clue about the effect of their speaking about him as if there was no one personally affected present.

Sorry, no pass. Such conversations should be held outside the hearing of patient and family, and a modicum of politeness should prevail when they are in the room with the patient. There is no excuse to treat a patient as if s/he were just a specimen pinned to a display.

[Art_Vandelay]

I think you have some misconceptions about care in a teaching hospital, and that's understandable, as you are not yet a nurse and this may have been the first time you were admitted to this particular hospital.

In your posts you have spoken of the residents in terms such as "learning on the floor that day" ... when in actuality they are licensed physicians who are providing your care, writing your orders and likely performing your procedures.

Rounding, or "checking on" hospitalized patients, is done by all physicians. In a teaching hospital it is usually a group format, and yes, it can seem like a herd of people. But they are not uninvited guests at your party ... they are the ones providing the care that you / your insurance is paying for.

Maybe the attending physician was abrupt. Ok. But from what you've presented in your posts, I don't see anything out of the ordinary. You were admitted for an endocrine problem. Another s/s of a possible endocrine disorder was discussed among the team taking care of you. It may be one that you are sensitive about ... but the discussion was about pathophysiology ... not to make you feel uncomfortable.

I hope this gives you a better understanding of hospital care.

I respectfully disagree that the OP has "misconceptions" about teaching hospitals. IMHO, the OP has a valid complaint. If I may, he/she was made to feel like an object and not a person. It's interesting to find that posters that have been in similar situations(made to feel objectified) can identify with this. I also feel that even though they are "licensed physicians", they are indeed still learning because they are brand new doctors. Just because the experience wasn't "out of the ordinary" does not make it exemplary care.

[liketheairport]

I've been admitted to this hospital on four separate occasions. This was the one and only time I was treated like that. The other times I was an "example", they knocked and introduced themselves to me. They also didn't make me feel like a specimen. I simply wanted to see what others' experiences were with this. I just hope that I can make a patient feel more comfortable if I am ever a nursing assistant or nurse in a teaching hospital.