Teaching Hospitals Use Team Approach to Medical Care

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July 7, 2000 -- In major hospitals all over the country, thousands of new untested "student doctors" will start work this week. They will often be among the first to see you if you happen to visit a hospital in the near future. And the doctors who were the "freshmen" last week will be among those supervising these new student doctors.

Scary? Not really, say the experts -- and the research. But doctors, hospital officials, consumer advocates, and patients tell WebMD that there are a few things you can do to make sure you get the best medical care if you need it in the first week of July -- or any other time, for that matter.

Because teaching hospitals are affiliated with major universities, they offer a training ground for medical students and new doctors. Students, interns, residents, and attending physicians work hand-in-hand to manage a high volume of unique cases. First-year residents, commonly known as interns, often have the most patient contact, but second- or third-year residents and attending physicians make most treatment decisions.

Every July, in most hospitals, new first-year residents start work and the former first-year residents become second-year residents, and second-year ones enter their third year, and so on. In addition to getting a group of untested docs, the hospital may also experience some confusion. This is why teaching hospitals deliver care as a team in which the more junior residents are supervised by senior ones, all of whom are ultimately supervised by an experienced doctor.

Referring to the television show ER, one resident says the team approach helps ensure safety. "Dr. Green prevents Dr. Carter from making patient management errors," says Randy Sharer, MD, a third-year resident at the University of Illinois and member-at-large of the American Medical Association's Residency Section. "Some patients get frustrated with the repetition and overlap, but it makes for a high level of care."

Sharer tells WebMD that students usually wear short white coats, while residents and attending physicians wear long coats. Either way, hospital research shows that patients are put off by the speed at which both work.

"Many people place physicians on a pedestal and are frustrated by the two-minute doctor," says Rick Wade, senior vice president of the American Hospital Association. "But ultimately, patients have to learn how to connect the dots" by providing the doctors with all the information they can.

"People with chronic illnesses should write down their medical history and carry it at all times," Wade tells WebMD. "A complete list of prescription and over-the-counter medications, vitamins, and dietary supplements helps too, especially in the fast-paced world of the emergency department."

Not only should you be involved in all aspects of your care, but you have a right to be, according to the Joint Commission on the Accreditation of Healthcare Organizations. This means knowing which team members can authorize treatment, plus the risks and benefits of treatment options.

After a serious car accident, one physician learned this lesson the hard way. "I needed surgery quickly, but I had to insist that they slow down and answer my questions about the procedure," says Mack Lipkin, MD, director of the primary care residency program and professor of medicine at New York University.

Lipkin tells WebMD that as interns begin their residency, hospital functions can slow down a bit. "Studies show that there's no change in quality of care at this time of year, but it's a good idea to have some extra family support along with you," he advises.

Consumer advocates couldn't agree more. "Just say no, if you're confused about the treatment plan," says Charles Inlander, president of People's Medical Society and co-author of Take This

Book to the Hospital With You. "You're not in custody, you're the customer. And regardless of visiting hours, you can have an advocate present around the clock".

While mourning the death of her husband, one woman regrets leaving his bedside. "At the time, I didn't know that I could've stayed after visiting hours," says Mary Albright, 71, a former teacher and grandmother of three. "Bill might have been more relaxed and less afraid if I'd been there all night. Besides, it's good to have two pairs of ears when the doctors come around in the morning."

Caring for her husband taught her how to navigate in a teaching hospital, Albright says. "I always had a list of questions and I insisted on clear, simple answers," she tells WebMD. "In standing up for our rights, I gradually developed a sense of faith and trust in the physician team."

But if conflicts arise, patients have the right to dismiss a doctor or ask for a second opinion. Most hospitals now have a patient or consumer advocate on staff. Looking back on a few occasions, Albright says she also might have asked, "How long have you been on duty, and how much sleep have you had?"


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