Teaching Hospitals - Do They TRY to Trick You?

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  • Raili
    Raili Member Posts: 435
    edited January 2010

    Patoo, thanks for your post!  I don't know how to quote posts on this message board, so forgive my lack of formatting - but you said:

    -----

    "Raili, I think I would have had the opposite reaction to yours. My PCP uses lots of students in her practice. Like your mammo dept resident, they usually come in first with their questions, taking notes and checking the site. Then the doc comes in and asks if there are questions which I'm believeing is to make sure I got all the information. So I would have said yes to the mammo resident as long as they were followed by the attending doc. Only problem is since the attending is not in the room how can they know the resident covered everything?

    Now, the surgical resident is another story. I don't have a problem with them being in the OR and "assisting" but your original post struck me with this statement: "Oh, and there will be a [resident, doctor-in-training, I forget what word she said] assisting me with the surgery, but don't worry, I'll be there the whole time." Why say you'll be there the whole time if the resident is only assisting? Sounds more like the resident will be perforing the procedure with the attending watching/coaching - now there is where I have a problem. I want "my" doctor to perform any procedure. Let the resident practice on a blow-up doll, cadaver, whatever, but not me!

    -------

    I can understand your reasoning here, about saying yes to the mammo resident and no to the surgical one!  But the fact that I would have said the opposite - yes to the surgical resident, and no to the mammo one - and for different reasons - just shows how important it is that hospitals GIVE patients the info and the time to ask questions and make an informed choice, instead of assuming that all patients would feel the same way...or that what works for one patient works just as well for the other.

    My reasons for wanting to allow the surgical resident but not the mammo one are

    1) I'm extremely uncomfortable with men touching my breasts.  I'd been warned ahead of time that the radiologist would be male, but I wasn't at all warned about the male resident that would be assisting him.  So finding TWO male doctors there, when I was having a hard time even preparing myself for ONE, made me even more uncomfortable.  I did not trust the senior doctor enough to trust his judgment regarding the resident, because I'd never met either of them before.  

    2) At least with the male surgical resident touching my breast, I'd be under anesthesia and wouldn't know it was happening.  Also, I fully trust my surgeon; she's highly trained and the director of the program, and thus, I did trust that even if the resident was doing a lot of the surgery, it was under her very close supervision and careful instruction.

    You and I both have valid reasons for which choices we would have made and why, but our reasons are different....Which is why I wish teaching hospitals would be more upfront about things.  Patients are different and have different needs!

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  • CaSux
    CaSux Member Posts: 74
    edited January 2010

    So here's a troubling story I came across a while back. It's from 2003, and I think that most teaching hospitals have banned the practice…

    Unauthorized Gynecological Exams By Med Students

    Practice vs. Privacy on Pelvic Exams (washingtonpost.com) - this is a more complete story, but the link won't take you there. If you paste the title into Google exactly you may be able to find it. It specifically mentions Johns Hopkins and Georgetown as being hospitals that condone the practice. CREEEEEEPY!!!!!

    Patient Dignity - this document gives more detail.

    … but, make sure you EXPLICITLY refuse consent for gyno exams, or consent to it if that is your wish, whilst under anesthesia. The consent form can be too general. Creepy. What IDIOT DOCTOR first thought it was a good idea?

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  • BFidelis
    BFidelis Member Posts: 156
    edited January 2010

    I also have had my treatment at a large university medical center.  I chose my PCP based on his affiliation with this institution.  I believe in good, solid training but my primary motivation was "the deep bench."  Sooner or later, most of us get something (or our SOs, kids, etc.) and you never know what it might be.  So I wanted the deep bench team -- cancer, heart disease, orthopedics, etc.  Years after that decision, I entered cancer world.

    I have been very open to being seen by residents -- saw it as opportunity to really help build better docs.  They were always introduced and very polite/respectful.  With one exception...

    I was really freaked about chemo.  And my surgeon's idiot office manager (I stopped seeing him because of her) went and made an appointment for me (yes, without my knowledge) for the onc consult.  Best of all, she didn't TELL ME!  (She had a bad attitude and was incompetant to boot.)  I had just about wrapped my head around the idea of making that initial appointment when I came home from work to find the onc's office had called to see why I had not kept my appointment.  Then I really freaked out.  (OK, I have issues about being in control, but all I could see was my actions, my life, being programmed by others.)  I informed my husband that I would not go for any consult. Well, a week or two later I decided that I really should go and hear them out, so I made an appointment with Dr. X.  Before the appt., I did some research on Dr. X, who was a woman and whose medical training was extensive and 'big name'.  So DH & I are seated in a smallish conference room (mind you I'm still pretty freaked) and in strides a guy who sits down and says, "I'm Dr. Mumblemumble and here's what we're going to do."  I went nuts.  I told him I had an appointment with Dr. X and that I knew Dr. X was a woman and he was not Dr. X and what is going on.  He proceeded to get very condescendingly defensive and informed me he was the fellow working with Dr. X.  I looked at DH and said, "I'm outta here."  At this point our fellow said something about getting Dr. X and left.  DH herded me back to the table and Dr. X and fellow were there in about 30 seconds.  She wasn't exactly apologetic, but she did the talking and the fellow kept his mouth shut.  It was all stuff I really didn't want to hear and when she said "bone scan" I really did lose it, stood up and said thank you, I'm leaving.  (Mom was dx'd stage IV from discovery of bone mets.  Those two little words were all the fear and pain I had ever known in my life crashing around me.)  DH hung back just long enough to say to her, "What's the next step" and she handed him a card with the number.

    I did go through with it.  On my first treatment day, I told her that I wanted her to know that I did truly respect her and I was in this 100%.  I told her I really wasn't an ass, but that I had tried so hard to be prepared and to be "ready" that when everything was different from what I expected, I really just freaked out.  She listened and was truly understanding and said she'd be really sure she never let that happen again.  She's a really great doc.  I see her for all my follow-ups (so I don't have to go to that stupid troll's office.)

    So overall, I'm really OK with all the observers.  But I will also tell you that there are two other very known/respected univeristy medical centers equally close to me, and I would not want to be treated for a hangnail at either.  They are so full of themselves that I'm afraid their egos could jeopardize their diagnoses/treatments.  Oh well, I guess that was a little more than 2 cents worth.

    Peace,

    Beth

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  • CaSux
    CaSux Member Posts: 74
    edited July 2010

    Ah, yes "fellows." These may be the most arrogant of the student doctors. They've completed residency and are doing a further education in a sub-specialty. I saw someone else post here about the "fellow" introducing himself so you could hear the quotes around his title. Very funny.

    Oncology "fellows" are really arrogant. They're also looking for patients of their own, depending on how close to the end of their fellowship they are - so there's a money thing involved with claiming patients.

    Good for you, Beth, for standing your ground.

    Also, agree that Hopkins isn't all it claims to be. I consulted there in the beginning, but went elsewhere for oncology, surgery, follow up treatment, and reconstruction. Bad vibe all around for various reasons. Big egos, little regard for individual experience, thinly veiled contempt, patronizing tone from nurse practitioners and up.

    Oh, and cut and paste mentality on visit notes. I got my record of the visits, a bunch of wrong information about my history was read or typed into the record. So in addition to everything else, Hopkins does sloppy work. Not life-threatening in my case, but who knows what other wrong info has been entered into someone's record that could cause a problem.

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  • DaylilyFan
    DaylilyFan Member Posts: 80
    edited February 2010

    When I was signing the consent form for surgery, the NP told me quite emphatically that this is a teaching hospital and other people will be in the operating room but that my doc would definitely be doing my surgery.  A relief because I was really suffering from info overload.   

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