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?

[Altra, 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.

[NicuGal, MSN, RN]

You will get a mass of people rounding on you each day. If you have 3 services each services comes separately. Now this doc should have asked you the question and explained why he was asking (like PP said, it can be endocrine related). Unfortunately a lot of attendings are like that. The fellows and residents are better. And they are the ones that are inhouse all day and they will be the ones taking care of you.

For example, today I had the NICU team

Round, then the GI team came, then ID and then Neuro. All in the span of 4 hours. And they all asked the parents a bunch of questions and then they discuss everything right there. Then we kind of play clean up and re-explain everything they just said in better terms. Life in a teaching hospital. But you have better access to different services and more evidence based practice.

[DizzyLizzyNurse]

You can always ask who they are. If someone is rude, make a complaint along with their name and who they work for. In the hospital I work at, every new admission is given a small packet explaining what a head nurse is, RN, LPN, NA, intern, attending, etc is and what each does. There are pictures of all the pediatric interns explaining their name and title. It's a very nice little set up.

I can only tell you some pretty dated info, but it speaks to what you describe. My mom, in 1982-83, was s/p molar pregnancy. It was pretty brutal for her and she basically ended up delivering a dead baby. She was an inpatient in a teaching hospital and was talked to (about?) just the way you describe by an attending to some residents, without her permission or even advance notice. The attending even chastised her for crying when he examined her.

Her experience there led her to be so suspicious of medicine and hospitals that she ignored her breast cancer and pursued alternative medicine until she had both bleeding open wounds to her breasts and extensive mets, which she ultimately died from shortly after her 58th birthday--6 months after she finally dared to present to an ED, because her SOB was so unbearable she could no longer take a flight of stairs.

Was she crazy? Sure. She had experienced a childhood of sexual abuse, and was told no one believed her about that, so she didn't really have it in her to advocate for herself.

One of the saddest moments in my life was in the middle of the night at MD Anderson in Houston, when she was about a month from dying. She held both of my hands and said, "if I had known they'd be so nice, I'd never have waited this long."

If you're an RN at a teaching hospital, please keep this in mind. As a nurse myself now, I see both sides. I just hope I'm never as callous as that attending my mom described.

How horribly sad. I stayed away from the dentist for a couple of years due to a mean dentist who told me to "Quit yelling. They can hear you in the waiting room" when I was yelling because the novacaine wasn't working during a root canal. I did some homework and found a very nice dentist who specializes in people afraid of the dentist and who will sedate someone if that's what it takes to get them to come get their dental work done.

[applewhitern, BSN, RN]

I have only worked in one teaching hospital, but I worked there for many years. Yes, that was pretty much the way it was there, too. The faculty doctors have their hands full with green residents and interns, and they have a ton of patients. This doctor's objective was to teach; don't take it personally. I'm sure he didn't slight you on purpose.

[classicdame, MSN, EdD]

fine print or not I would have told the MD to work on his bedside manner. Or tell him you prefer not to be seen by that group. What are they going to do, kick you out?

[NicuGal, MSN, RN]

Actually, if they are the only team in service you don't have much if a choice. They may be able to switch out attendings if more than one is on that month but the fellows and residents are the same.

[roser13, ASN, RN]

My daughter, at 6 weeks of age, developed spinal meningitis. This was back in the day that you had to wait out a 3-day period, watching the Agar plate to see if bacteria grew. If not, the meningitis was viral. I sat in that hospital for 3 days, enduring the flock of interns/residents who swarmed into the room, sometimes twice a day, listening to my daughter referred to as the "subject." Never once was I even acknowledged as being present in the room.

I was not a nurse at the time but had always had a great interest in all things medical. On the third morning, after listening to the discusions for the previous 2 days, I picked up on something that the Attending mentioned. I asked a question about what he was referencing and I about got my head handed to me. He actually asked me "how" I knew that word and did I really understanding what I was talking about? If I recall, the secret medical language word was 'viral' :)

[liketheairport]

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.

It's like the last slice of pizza. Will I probably say you can have it? Yes. But, you can't assume, and thus should ask.

[llg, PhD, RN]

1. I think the situation is improving a little in some places as even physicians are learning a little more about customer services. They still make rounds with residents, students, guest observers, etc. ... but some are getting better at intorducing themselves.

2. Nurses, nursing instructors, and nursing students can be just as bad. If a patient is sufficiently "interesting," a lot of people will want to share in the learning opportunity.

[Katie71275]

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.

[MunoRN, RN]

Every Doctor knows what they know thanks to the many patients before you who went through the same thing, it's only fair for you to pay that forward.

If you want someone who is sensitive to how this makes you feel, don't look to the Doctors, that's why you have Nurses.

[liketheairport]

I think doctors, nurses, CNAs, techs, whatever could benefit from learning how to ASK the patient. I wasn't acting out, I was being completely open to treatment, etc., and answering questions. Would it have killed the doctor to simply say "Hey, I've got some residents here, would it be OK to come ask you some questions?" Were I teaching doc, I would. Patients are people.