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What Really Happens at a Teaching Hospital?

Did you ever wonder what really happens at a teaching hospital? Jeffrey Schneider, MD, is here to break up some of the myths and confusion and to help us understand what a teaching hospital is really like, and how it can benefit patients in so many ways.

Featured Speaker:

Jeffrey Schneider, MD

Jeffrey Schneider, MD, FACEP, FAAEM, received his undergraduate degree from Brown University and his medical degree from the University of Massachusetts School of Medicine. He is an Assistant Professor in the Department of Emergency Medicine at Boston Medical Center/Boston University School of Medicine. A nationally recognized educator, Dr. Schneider is currently the Chair of the Graduate Medical Education Committee at Boston Medical Center, the Designated Institutional Official for ACGME where he oversees the more than 60 training programs across the organization, and the Assistant Dean for Graduate Medical Education. 

Dr. Schneider has served as a mentor and advisor for countless students, residents, and junior faculty, and he has published in both the emergency medicine and graduate medical education literature.

Transcription:

Melanie Cole (Host): Did you ever wonder what really happens when you go to a teaching hospital? Well my guest today is here to clear this up. It’s Dr. Jeffrey Schneider. He’s an emergency medicine physician and Chair of the Graduate Medical Education Committee at Boston Medical Center. Welcome to the show Dr. Schneider. So, this a great topic. Tell us first, what’s the difference between a teaching hospital and a non-teaching hospital?

Jeffrey Schneider, MD (Guest): Well thank you very much for having me and I think importantly, both teaching hospitals and non-teaching hospitals are very valuable to medicine in our country and certainly in the city of Boston in Massachusetts. But there are a couple of important differences between teaching hospitals and non-teaching hospitals. Kind of at a high level and traditionally, teaching hospitals are doing exactly that, teaching the next generation of medical students, physicians, often of nurses and nurse practitioners and physician’s assistants, respiratory therapists, and other members of the treatment team. They generally are very involved in research and as a result, value learning just as much as they value teaching, where you are often met with resident physicians for example who are in the midst of their training program and depending on what specialty they may be going into, that could be one year, all the way up to seven years if not longer really learning kind of the craft that they look forward to working with throughout their career. 

Melanie: So, who see you at a teaching hospital? Do you get opinions from more than one physician and I think what a lot of patients want to know Dr. Schneider is are residents doctors?

Dr. Schneider: Yes. So, you will certainly be seen and get opinions from more than one physician at a teaching hospital and to make it very simple, residents are absolutely physicians and they are doctors. They are people that have graduated from medical school and have entered into their residency which is additional training anywhere from maybe one year all the way up to seven years where they learn a particular aspect of medicine. For example, dermatology or emergency medicine or acute care surgery and learn the specifics of how to be a cardiologist for example. When you are in a teaching hospital, you will certainly get seen by lots of physicians. You will get opinions from many as well. As we work in team, which is generally kind of a senior physician the attending who is ultimately responsible for particular patient care and underneath that attending, he or she may have a handful of maybe senior residents, junior residents, medical students, and other learners who are in our community who are all working towards the same goal, taking the best care we possibly can of that particular patient. 

Melanie: Then let’s break up a few myths for the listeners. People worry if they go to a teaching hospital that doctors and students will you know, be not experimenting on them, but practicing on them for training purposes. How does that work?

Dr. Schneider: That’s a great question and I think it’s a common myth, but I often hear in my work and I certainly want to debunk it. There is certainly no practicing as you said or even experimenting on patients at teaching hospitals. As I mentioned earlier, teaching hospitals have a real responsibility to incorporate the latest techniques, the latest medical advances into their treatment because we are training tomorrow’s doctors. And not incorporating those treatments and techniques would be really doing a disservice not only to our patients today, but our patients in the future and those physicians who are fallowing behind us. As attending physicians, as I said we are kind of ultimately responsible for that particular patient’s care and I think as we know the care that we provide and probably true for anything that we do, to really understand something and to really be able to implement it in the most patient friendly and patient centered way; we have to be able to understand it fully and there is no better way to understand something I think, than the ability to be able to teach it. So, it’s very important at teaching hospitals, that we are constantly being asked questions. The learners, the medical students, the residents, the fellows who are around us are constantly asking us why or why not or should we be doing this and that’s really, really important questions for us to contemplate, to answer, to think through to provide the best care that we can for our patients. 

Melanie: Well I certainly would think it keeps you on your toes and even helps you to learn new things being as experienced as you are, learn new things as you go from some of these students, now another myth that people might think about is that a doctor who is also a teacher may have less time for the patient or that they will get subpar treatment. 

Dr. Schneider: That’s a great question as well. I think many of us that choose to work in teaching facilities and teaching hospitals we are actually in many ways, many of the physicians that work here are the real experts in their field and again, our duty it to treat the next generation of physicians. We want those residents and fellows to learn from the best, those that are the absolute experts in their particular area of interest. And as a result, the time that we spend teaching is as important to us, as important to our patients and as important to our learners and as important to the hospital as the time we take care of patients. In fact, those two times, many of us don’t think as being any different from each other that those teaching and taking care of patients at exactly the same time and it’s very good for patients, it’s best for patient care, it’s best for learners and to be perfectly honest, it does keep us on our toes and it makes things a lot of fun as well. 

Melanie: What about privacy. So many patients are concerned Dr. Schneider about privacy these days. Does it mean that there will be a bunch of residents standing around learning about your situation, your case and what if it’s of sensitive nature or you are embarrassed to have all these other people, rather than your physician, who you are comfortable with and you know a little bit better. Speak about the privacy issue. 

Dr. Schneider: Sure, that’s a great question and I think the most important thing to remember is that patients have the right and we have the responsibility as physicians to making sure that they are comfortable. So, no patient should ever feel uncomfortable with those who are taking care of them, or those who are examining them in any kind of meaningful way. I think that’s very important for patients to understand. I would ask you to think of it from a slightly different perspective. Rather than having for example, just one physician examining you or asking you questions; the fact that we have multiple, I think is very helpful. It helps us with better patient outcomes and there is pretty good literature demonstrating that things like mortality or people who pass away from a variety of conditions at teaching hospitals is probably a little bit better in many instances than in non-teaching hospitals. And there are lots of theories about why that might be true. But from the perspective of having more people asking you questions or more physicians examining you; I think it’s a series of checks and balances where we are constantly checking each other, asking each other what did you see, what did you hear, what did you find, what do you think as we all work together to take the best possible care for patients, I think that’s a really important aspect. But it’s also very important for patients to understand that their privacy is of the utmost concern to all of us and that patients should never feel uncomfortable that their privacy is in any way being compromised nor will it.

Melanie: I think one of the biggest fears and or myths that patients might have when they are at a teaching hospital is if they have to have surgery. Do they know who is really doing the procedure and is their physician, their surgeon doing this procedure or are they letting the residents kind of take hold and learn this procedure? I mean they have to learn somehow, but I think that this is a big fear of patients. 

Dr. Schneider: Sure. That’s a great question as well and again, I would encourage patients to ask questions. There is no question that a patient can ask which is any way inappropriate and it’s absolutely fine to ask the physician taking care of you who is going to be doing what and how will that impact me and who is more experienced and lesser experienced. But really importantly in the operating room for example and you mentioned surgeries, the attending physicians are intimately involved in the care that that patient is doing and the team-based approach is really, really important. There are many operations for example where you just need more than one pair of hands and that’s really important for the entire team whether it be nurses, physicians, technicians, all working together to take the best possible care of that patient. But patients should always know that they are getting excellent care and that asking who will be doing what is very, very important. There are I think the myths and the things - the way things used to happen in medicine many years ago with relatively inexperienced residents taking care of patients independently without appropriate supervision. Those days thankfully are entirely gone and certainly at Boston Medical Center. We are very, very careful and thoughtful about what individual physicians should be doing, at what level of training, what kind of supervision they should be – that should be in place to again to ensure the best possible patient outcome and the utmost patient safety. 

Melanie: That’s very reassuring Dr. Schneider and you’re putting it so well. It’s really – you’re making us really understand what a teaching hospital is all about. So, wrap it up for us with how patients can ensure they receive the best care possible. What would you like them to be – you said have them ask questions and that any question is a good question. What would you like them to ask about a teaching hospital? How can patients be their own best health advocate?

Dr. Schneider: That’s a great question and I think very important and something that I think traditionally in medicine, to be perfectly honest, we haven’t always done as well as we could have to engage patients to ask them what they are understanding, what their questions are and I would definitely encourage patients if you are not sure, if things don’t make sense, repeat things back to the physician. Repeat things back to your caregivers and part of your caregiving team and ask am I understanding this correctly. Is this what’s going to happen next. What is the next day look like or maybe even the next fifteen minutes or the next hour or the next month. Ask those questions to make sure that we are all on the same page. It’s really important to us. It’s really important to patient outcome that we all understand how we anticipate things unfolding and how we anticipate that we can provide the best possible and the safest care for our patients. We are all on the same team. we are all pulling in the same direction and as a result, we all certainly need to be on the same page. 

Melanie: Wonderful information. Dr. Schneider, thank you so much for sharing your expertise and explaining a teaching hospital to us. It really does help to clear up some of those myths. This is Boston Med Talks with Boston Medical Center. For more information on Boston Medical Center as a teaching hospital, you can go to www.bmc.org that’s www.bmc.org. This is Melanie Cole. Thanks so much for tuning in.