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?

[liketheairport]

This particular hospital contracts with another healthcare corporation to be the go between my doctor(s) and me. I don't necessarily think it's the wrong thing to do, I just wonder how many patients feel slighted being in this situation.

[notsureabout1]

When patients complain about teaching hospitals and the herd of residents rounding on them or saying they feel like a guinea pig/lab rat/pin cushion, the most common response from the people in teaching hospitals is usually along the lines of "Well, you chose to come to a teaching hospital. If you did not want this you should have gone somewhere else". As if patients have any choice about anything. Any time I have ever been in a teaching hospital or any member of my family has it has never, I repeat, never been by choice. It was either insurance only paid for University of X Hospital b/c this person was a student, or Dr. Y said to that someone HAD to have surgery there and refused to go anywhere else. There are no non-teaching children's hospitals in our entire state so if a kid has to get treatment, we have zero choice. Trust me, if I had any choice at all and could avoid a teaching hospital I would. Sometimes we have zero choice in the matter so the "well it was your choice to come here" argument really makes no sense.

[monkeybug]

It seems pretty common at teaching hospitals, but I work at one, and we don't do it here. Granted I'm on the labor unit. Our docs are great at coming in(usually just 1-2) and introducing themselves and asking if it's OK.

Consider yourself blessed, then. My last hospital was a hybrid, we had a residency program but they were by no means our largest group of physicians. It was torture for the nurses. On a good day, you had the patient of Private Dr. X. You would triage a patient, check their cervix, watch the monitor, call the doc, get orders, admit with all that that entails. Doc would come over and see the patient, and maybe break water. When patient desired (that was the way the orders read) we got an epidural. Doc would drop in a couple of more times depending on the length of labor. If we needed internal monitors, the nurses placed them, or we asked when the doc was present. When patient was 10cm, we called the doc who gave us the go ahead to push. Nurse and mom would work together to get the baby out, nurse coaching and doing perineal massage, mom doing the hard part! When the baby was crowning we'd call the doc and they'd come in and catch. They'd suture if needed, thank us kindly, and then get out of our way.

On a BAD day, we'd have a patient from the medical school. They'd send a patient to triage. We would page resident A to come check their cervix. And page, and page, and page again. We'd finally tell them that we were going to do it unless they showed up in the next 5 minutes. Often they would express some shock that we COULD check a cervix if they were interns (no, you fine specimen, all I can do is fluff pillows). Resident A would check, and then sometimes ask us to check behind them.

Or in one memorable case, the interesting "doctor" asked me to put my fingers up to his bloody glove in order to interpret the centimeters. They would then leave the room and call their upper level, who would call the attending. 20 minutes later we would get the word that we were going to watch her for another 2 hours. 2 hours later, lather, rinse, repeat. 20 minutes after THIS we'd get admit orders, but they would change the part about "epidural when patient desires" to 4cm. You go in the room to try to get your admission done, the med student comes in and wants to know things like how old she was when she started her period. At this point patient is madder than a hornet and in pain, and feels like she's being put through the wringer. I generally would pat them on the shoulder and offer them the complaint line number. Patient asks for epidural. She knows from her sister and cousin that she can have it whenever she wants. I get to inform her that her sister and cousin had the good sense to choose the private docs. She gets to wait. I go page Resident A to explain this again to the tearful, tired, laboring woman who just wants some relief. 30 mintues later he answers and tells me he doesn't have the time to discuss his order with his patient, she'll just have to wait. I vow internally to wake him every 30 minutes form 2 am onwards with I & O reports to see how he enjoys being kept from relief. Finally he comes down and checks patient again, roughly, and then chides her because "it can't hurt that bad." I inwardly vow to use some Kellys on his nether regions to give him some empathy. Finally we get to 4cm and get an epidural. Every two hours my patient's rest is disturbed by Resident A, Resident B, and med student who all 3 want to do cervical checks. Water has finally broken on its own and I have to try to control my temper and explain, respectfully, why this isn't a good idea. "Yes, I know she's numb, but that's not the point. We're talking about infection now, gentlemen." Finally we get to 10 cm. 3 residents gown and glove (money down the toilet, they won't be laying hands on her, but they want to look cool, and those sterile gloves and gowns don't come cheap). Attending makes his first appearance, does not gown and glove, and sits in the rocking chair playing on his phone. 3rd year med student is in the driver's seat. I'm wedged in to a corner between monitor and bed. I can't tell how well my patient is pushing. Med student has firmly applied a towel-clad hand over the perineum despite the fact that baby is at -2 station so we don't have to worry at all yet about lacerations. Instead of a peaceful hour of laboring down followed by some effective pushing, we're pushing from the minus stations and patient is beyond worn out. Also, med student has this god-awful annoying monotone "one and two and three and..." Patient occasionally looks at me like a puppy that has been kicked. Finally we have a baby, which med student promptly drops into the placenta bucket (oh how I wish I was making this up). Baby seems none the worse for wear, but I suppose we won't really know until his SAT scores come in. Suturing commences, and is a group effort. They finish, and all of them troop out after pulling gowns and gloves off and leaving them on the floor. My room looks like a hurricane has come through it, and I am contemplating homicide.

THIS, this is what we dealt with on a daily basis at my last job. If you were one of the first nurses through the door, you grabbed a patient of one of the private docs. Last in, and you were stuck with THEM, and you could guarantee yourself a day full of frustration and repetition. I know there are people that just love teaching facilities. I've worked all over and seen it done different ways, and I hate to tempt God, but if it is at all within my control, I will NEVER EVER work with residents again. Many of them are decent and caring, but the whole machinery is so inefficient, and the patient is often the last person considered. I got tired of arguing over stupid things like why it would be over my dead body that the laboring woman at 6 cm was going to have a speculum exam. You want to fern something? Fern the puddle in the floor and have some stinking common sense! I know for sure she's ruptured because I'm standing in a puddle and I have a sense of smell, and just because the med student has never done a speculum exam before does not mean he's starting today!

[nurseprnRN, BSN, RN]

At a teaching facility you are fair game....when you are admitted it's in the fine print...it is in the consent to treatment.

True, but you can still refuse anyone's care and attention, including house staff, and if it's a teaching hospital, it's important to realize that some things you learn aren't in the syllabus. All names changed...

My child was in a nationally-famous children's hospital after van-vs-bicycle trauma (thankfully no permanent disability, but it was a lousy couple of months). She had, among other painful things, a couple of JP drains in her leg. Her second post-op morning the Chief Resident in plastics, Robert, came in at 0645 with the retinue of residents and students, pulled down her covers, yanked off her dressing to look at her wounds, whanged the JPs around a bit, slapped it back on haphazardly while calling for a nurse to replace it, and walked out without a word to her (by now in tears) or to me, who was right there in the room. I was speechless, but mad. So the next day, I said, it would be different.

0645 again. Crowd enters noisily in the door. Chief Resident reaches for covers. "Good morning, Susie. Is it ok if I look at your dressing?" That was me speaking. His hand froze. I spoke again. "'Good morning, Susie. Is it ok if I look at your dressing?' That's what YOU say." He got very red, and the crowd behind his back looked sideways at each other.

Then he spoke. "Good morning, Susie. Is it ok if I look at your dressing?""

She said, "Yes, but please be careful not to move those tubes around so much because that really hurts."

He was noticeably more careful, put things back together nicely, and left without a word. A few of the retinue cast a glance backwards at us as they followed him.

Later that day the Chief of Plastics, the attending, one of those lovely physicians for whom nurses would walk barefoot over broken glass, dropped in during naptime. He sat with me and we spoke quietly in the dim light. "Heard you had some words with Robert," he smiled.

I answered, "I guess word gets around. I am sure if he's your chief he's really good technically, but he has a helluva lot to learn about bedside manner." He nodded, and said the students took the lesson. I saw that man off and on in the course of my work for years afterwords, and he never failed to ask after her.

And Robert never entered the room again. I don't know if he rotated off the adolescent service or what, but never again.

[nurseprnRN, BSN, RN]

At my facility (a large academic medical center typically ranked in the top ten in the US), the attendings and residents/students are pretty civilized and sensitive, but you (as a client) do have crowds of people you don't know traipsing through your room to discuss your situation and treatment. It's a teaching hospital. As already noted, the consent to have students and residents involved in your care, and to be used as a teaching case, is written into the consent form you signed in order to be admitted. This is the trade-off for getting world-class, cutting edge medical care.

Interesting that people believe that. I live within an hour's drive of the medical mecca of the world with many teaching hospitals and three medical schools (including House of God's BMS), and recent research indicates that patient care is better, complications and infections less common, outcomes better, patient satisfaction better, and costs lower at the community hospitals outside of town. This is still true when you adjust for acuity, age, and premorbid conditions. Across the board.

The BMS and its partners get all the ink, but you'll never catch me going there for care.

[applesxoranges, BSN, RN]

I would ask if you can put up a sign. Usually the residents I see round in small groups like one attending and two residents. If it was a bunch, it may have been medical students. Those usually were in the upwards of six to ten per attending.

I have seen signs that say "no students" on the doors. I would have asked your nurse about it.

[blueheaven]

Glad that the attendings, residents, interns etc. are civilized and sensitive at your facility. Guess if they aren't, they get sent to other programs. Wish this was the same in the facilities I've seen.

[blueheaven]

Amen sis!