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Re: A favor from our readers
From: D. Ashley Hill, MD (anonymous@obgyn.net)
Sun, 13 Feb 2000 10:49:12 -0600 (CST)
Thanks to everyone for their comments thus far. I am familiar with the
unfortunate situations that "sweetpea" wrote about. Fortunately, we do
not behave that way at our office, as the residents are always
introduced and patients are offered the opportunity to decline
participation. Further, medicaid rules now require that an attending
physician interview and examine all patients under a resident's care.
This is a good rule, although it has placed a burden on many teaching
programs. In our office residents are part of the history/physical, so
they ask questions and help with the exam. Since they are Family
Practice residents my patients with non-gynecologic problems are very
pleased, because they get a free second opinion about their
hypertension, diabetes, or funny looking mole! The majority of my
patients seem to like it, because I teach to both the patient and the
resident (using non-medical terminology). That way everone wins. Still,
I would like to develop a protocol that allows for teaching but is
patient-centered, so no patient feels that she is an unwilling
participant. Thanks again. I am done with the yard and am taking my
wife to the beach this afternoon. I hope everyone had an enjoyable
weekend.
At Sun, 13 Feb 2000, anonymous@obgyn.net wrote:
>
>At Sun, 13 Feb 2000, D. Ashley Hill, MD wrote:
>
>>Any insight into this from our readers?
>
>I've spent the last 2 years getting medical care from a teaching
>institute. Annoying observations:
>
>1. Residents don't speak. It's like someone chopped off their tongues.
>A class in communication would be nice.
>2. When accompanied by the teaching gyn, the resident is RARELY
>introduced. By my count, that makes him/her a total stranger with no
>business in the room.
>3. The teaching physician often does not behave or speak to me as he
>normally would. I get entirely different care when a resident is
>present.
>4. Questions from the patient aren't "allowed" when a resident is
>present. Oftentimes the teaching physician seems to think he must also
>teach the resident how to "be in control." I never get my questions
>answered when a resident is present. I always end up emailing the doc
>later.
>5. Many "teaching physicians" use residents to do all the work and they
>themselves have little to no input or even bother to review the work or
>be present. Some even refuse to review the work upon patient request.
>(I had this happen just last week. After spending an hour with a
>resident and an intern, I was uncomfortable with both. I asked them to
>please ask the "teaching physician" to come in. He did -- and proceeded
>to tell me that he didn't "oversee" his residents' or his interns' work.
>That, unless I allowed these other 2 men to finish their work, he, the
>doctor I actually had the appointment with, would not even speak with me
>further. Then he left the room. I thought about it. Then I left as
>well.)
>6. Giving long case histories to 1 person is a pain. Giving it to 3,
>each separately, is a royal pain. (I've had this happen too.)
>
>I have no patience left for the "teaching institute" and now regularly
>write into the consent form my requirements that must be met prior to a
>resident being even present in the room. Including the littlest things
>like "All personnel must be appropriately introduced and their medical
>degree and function identified."
>
>You asked for insight. Just one patient's perspective.
>
>sweetpea@loveable.com
--
David Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
http://home.mpinet.net/dahmd
My apologies, but due to time constraints I am unable to answer private e-mails.
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