How different are learning/teaching hospitals?
 

Ok, so a quick story.

I just got back from the hospital with Viral Meningitis.

However, since I currently don't have any health insurance, I went to the University of Toledo's Medical Hospital, which is a teaching hospital.

I've been to a few different hospitals in my life, and I've received some really great care, and some really bad care. However, this hospital was pretty solid. I was taken to a room in the ER almost instantly, and everyone was really professional.

Despite not having insurance, I was admitted for 3 days, and treated/given drugs and a ton of doctors talked to me, and helped diagnose me. (Took them awhile to be sure, as I had a few other things wrong w/ me as well).


So anyways, I did find a few things interesting about my trip to the hospital;

1) I saw atleast 6 different doctors, some were residents, and others were regular doc's. Is this the norm in teaching hospitals? Also, occasionally, groups of 5-6 doctors would come in, and give me a kind of group exam/checkup.

2) Despite not having insurance, I was admitted, and it was never made an issue. I know they have a sliding scale payment method, but I honestly didn't expect to be admitted and taken such good care of w/o insurance.

3) This is a semi-related thing, they gave me morphine, and it did like *nothing* for my pain. Painkillers do work for me, as I'm on vicodine right now, and feel fine, but morphine did nothing for me. I didn't even think that was possible.

Anyways, I'm just curious as to your thoughts on teaching hospitals as opposed to regular hospitals.

2) I don't know how it varies from state to state, but in Pennsylvania a hospital cannot legally refuse to treat you even if they can prove you don't have resources to pay.

3) They probably are in the habit of giving low doses in the hospital to combat the ever invading drug abuses who are trying to scam new physicians for free drugs and scripts. It also possibly saved you some money.

1) As for all the doctors you got to see, almost all of them were probably still students. Though they may have been board certified, they're still a long way from being able to practice medicine on their own. The ones who were actually residents were double checking all their work because every time a student saw you it was basically a quiz for them. Of all the folks you got to see claiming to be a doctor, only one or two of them really were.

Source: College room-mate/grooms-man currently in his fourth year at U. of Pittsburgh School of Medicine.

Whoa, not so fast.
Nobody in the hospital should introduce themselves as a Doctor if they are not.
Med students should know better and if they don't kindly folks like me will remind them, nicely at first. Warn your roommate before someone not so nice as me finds him claiming to be a Doctor and leaves tire tracks down his back.
Med students are most certainly not "Board Certified". Only physicians are and if the physicians you saw are Boarded then they should be capable of practicing medicine..

A student who graduates Medical School is officially a "doctor." Once they graduate, they have to spend a minimum of three years learning in a hospital environment. During these three years, they are known as "residents." First-year residents are known as "interns." Once they finish their residency, they can either be an "attending" physician at the hospital, go into family practice, or go on to further learning in a specialty, known as Fellowships. Once they complete the program, they can be Board-certified in that specialty.

As far as whether the care you receive will be better or worse than in a non-teaching hospital depends on how closely the residents are watched over by the attending physicians.
Also, vicodin is a morphine derivative, so it's impossible for one to give you relief while the other one won't. Taking vicodin will raise your tolerance to morphine, though. That's probably what happened.

Disclaimer: I'm no doctor, so if there are any here who want to correct me, feel free.

Residents are, actually, to be called "Doctor." They have graduated from medical school with their MD (or whatever medical degree they were pursuing), and so have earned the "Dr." in front of their names. However, in some jurisdictions, they must complete a residency before being able to practice, even if they have the degree. So, yes, you would call a resident "Dr. So-and-So" even if he/she isn't the supervising physician.

The teaching hospitals I have been to in the US and Japan have been very solid in their medicine. I think part of the reason is that the doctors are teaching real medicine, nuts and bolts diagnostics and treatments. They are conservative with the tests, not running extraneous tests to force up the bill. They are conservative with the medicines, because they aren't (as far as I can tell) beholden to the drug companies to prescribe the most expensive/ most profitable/ highest kickback drugs to pad the bill and line their pockets. I have no problem helping residents become better doctors by learning something from my conditions. In fact, I am happy to contribute in this environment because, so far anyway, there has been a "real" doctor to supervise and double check anything they do.

I'm sure there are horror stories out there about the mistakes residents have made, but by and large, I don't think they are more common or more serious than the mistakes "real" doctors make. That's just my experience.

As far as quality of care goes: some of my family members have been treated in hospitals that were affiliated with teaching hospitals. The care was great. Personally, I've never been treated in one, but that is largely because I am not prone to hospital visits. :)

Additionally, you may be treated by a fellow in a non-teaching hospital. A friend is a fellow in rehabilitative medicine, and she does rotations to different hospitals around the area where her teaching hospital is.

I felt I had better care given to me at John Sealy in Galveston (teaching hospital), than my local hospital.
I had to wait forever for a nurse (and especially my doctor) at my regular hospital.
The teaching one usually had someone always on hand.
Sometimes they were hell on starting IV's, but overall it was a better experience.

I was at a teaching hospital for nurses in a town near here that was my best experience by far.
I swear, if I hadn't been sick, it would've been almost like a vacation.
Nursing students are eager to please.
I remember one little blond with green eyes...*sigh*...mama mia!

Anyway, yup, I prefer teaching hospitals.

Yes, it is normal. The residents will see you and develop the treatment plan, then the attendings they are working under will give you a quick exam to make sure nothing is missed.
The groups are rounding. A flock of residents will follow an attending around who presents a case so they can question the residents about it. See if they know their stuff.

Hospital have to care for whoever graces their doorway. Its illegal for them to turn anyone away based on ability to pay.

That can happen. Might be the dosage as well.

I never said he introduces himself as a doctor, nor does any other student that I'm aware of who has not graduated from school.

I was pointing out what PonyPotato was - that there is a gap between when a person earns the title "Doctor" and when they are able to practice medicine unsupervised. In that gap the doctors are still students.

I meant something other than what I think you meant by 'board certified'. I mean they had passed the licensing exam, which I've heard commonly referred to as 'boards'. I realize 'board certified' is used more commonly in reference to recognition of specialized training by the ABMS.

I am a physician so I will pipe in. Teaching hospitals are a great place to get medical care, but they are not all the same. Some are privately owned and "for profit." Some are owned by a university. Some are county or state run and others are run by a non profit entity such as a church. They same differences occur among non teaching hospitals. Community teaching hospitals tend to do less research and have fewer residents (and even fewer or no medical students). Many patients in these hospitals are cared for by private physicians and never see a resident. Some community hospitals will have student nurses but no one studying to become a physician. The bottom line is that there are people having good experiences and some having bad experiences in every hospital all the time.

People enter medical school after completing an undergraduate degree. That degree can be in anything, but they need to have a year of Biology, one of Inorganic Chemistry, one of Organic Chemistry, one of physics, and one of English. The first two years are spent on the basic sciences in a large lecture hall and some smaller labs sections. Then number of hours in class is close to twice that as an undergraduate and the volume of information per hour is more like three times that you would see in a college course.

The third year of medical school is spent doing hospital and clinic rotations through most of the major specialties. It generally lasts a full 12 months and most is mandatory with little if any room for elective choices. These are the students you would have seen in hospital. They can be distinguished from graduates of medical school by their short lab coats and innocent looks. During this time the student needs to make a choice of specialty because applications for residency are due early in the fourth year, which is mostly elective and shorter than the third year. All the graduating medical students in the country find out where they will go after graduation on the same day in March called Match Day when a computer sorts out the applicant's rankings with those of the programs.

Residency programs are run by teaching hospitals and they employ newly graduated MDs or DOs on a salary that often does not add up to minimum wage. The hours are nuts but they need to be to fit in the experience needed. There are restrictions on hours worked now but there are no restrictions when you get out on your own.

The first year residents are called interns (they used to live in the hospital in the past) and they are not allowed to work on their own. There used to be three tracts to getting a license but I think they have been merged. When I went through I took Part 1 of the National Boards at the end of Med School year 2. Then Part 2 was during the fourth year. Part 3 was taken during the middle of Internship. If you passed all three you can get a license to practice medicine as soon as you finish your internship. You are then a General Practitioner. There are very few who stop there and they are not able to get hospital admitting privileges or get on insurance panels.

Upper level residents supervise the interns and medical students while being supervised by attendings. The level of supervision by the attending will depend on the individuals involved and how close they are to finishing their training.

Upon finishing residency most doctors chose to sit for specialty boards. Some are written only and some also require an oral test. Procedure based specialties have to submit procedure logs to be able to sit for the test. All boards have to be renewed (mine are every ten years). Some specialties are actually subspecialties of other specialties and are taught in Fellowships following residency.

Family Practice and Internal Medicine are 3 year residencies and are not the same thing, although they have a lot of similarities in the US. In other countries Family Docs do ambulatory medicine (outpatient) while Internists are hospitalists. There are a lot of subspecialities one can chose in Internal Med.

General Surgery is 5 years. They can then do fellowships in Vascular, Cardiothoracic, or Plastic surgery.

Surgical subspecialities like ENT, Orthopedics, Urology, and OB-Gyn are separate 4 year residencies.


This went on longer than I intended but I thought I would straighten out a few misunderstandings.

Never apologize for making us better informed, greytone!

Indeed. Thanks for the post Grey :)

From what I understand, both morphine and vicodin (hydrocodone) are opiates that attach to CNS receptors. While morphine is pound-for-pound "stronger" than hydrocodone, most forms of synthetic hydrocodone contain some form of fever-reducer/non-steroidal anti-inflammatory like acetaminophen or acetylsalicylic acid.

If I had to guess, I'd say that it's the anti-inflammatory/fever-reducers that are what's making the difference as one of the main symptoms of viral meningitis is inflammation of the membranes covering the brain and spinal cord. But this is all an uneducated guess as I'm still in my second year of pre-med and wont be studying pharmacology for a while.

Great point. When I stated earlier that it was impossible to get relief from one without the other, I was forgetting that. I was basing my answer on the fact that hydrocodone (the narcotic in vicodin) is morphine based, while drugs such as percocet are codeine based.

Now that you mention it, I remember years ago having a really bad toothache and my wife gave me a percocet - didn't do a thing. Later on I took some ibuprofen, and it disappeared within 10 minutes, because the tooth was inflamed from an abscess.

Acetaminophen (Tylenol) is not an NSAID (not steroidal anti-inflammatory drug) and adds to the analgesic effect of the hydrocodone as simply another pain med. All opiates work on the same receptor in the brain and there are tables that compare dose equivalencies and Morphine is certainly stronger than hydrocodone but you may not have been given a big enough dose for the pain you were having at the time. At another time it will almost certainly work for you.

I appreciate the correction. Other than that, how far off was I? Could the presence of a non-steroidal anti-inflammatory like ASA in hydrocodone be what made the difference?

Maybe, but too many unknowns to know for sure. More likely different pain level relative to the dfferent doses of the opiates.