Patients Need Patience

Patients Feel Cultural Shift at Athens Hospitals

A cultural shift is underway in the two community hospitals that have been serving Athens for generations.

For the first time, patients may find themselves talking to medical students as well as to experienced physicians at Athens Regional Medical Center or St. Mary’s Hospital.

Since July, 40 third-year students from the Georgia Health Science University-University of Georgia Medical Partnership have been enrolled in clinical clerkships, short periods of hands-on training in specialties ranging from obstetrics and gynecology to neurology.

As they rotate from one clinical specialty to the next, students observe their preceptors’ every move and follow suit under tight supervision. More than 140 Athens-area physicians signed up to teach the students, according to Dr. Michelle Nuss, the campus associate dean for graduate medical education.

Patients at established teaching hospitals in Atlanta or Augusta are accustomed to seeing senior physicians trailed by residents, interns, and medical students. But Athens patients are still getting used to the idea of interacting with smart young people who are on the road to becoming doctors, but aren’t there yet.

“Patients are used to having a private meeting, discussion, and relationship,” said surgeon Toby Tally, who coordinates surgical clerkships for the new medical school. “Now, there is another person in the room, so that makes people uncomfortable,” she said.

Patients may also be unsure how they should relate to the students.

“For a lot of patients, they don’t understand what the role of a medical student is,” said Dr. Terrence Steyer, who chairs the Department of Clinical Sciences at the med school. Not knowing exactly what a student can or cannot do may cause patients to expect too much – or too little from doctors-in-training.

Uncertainty aside, there is evidence that students can play a positive role in how patients experience their own care.

In one recent study, two-thirds of patients approved of med students being in hospitals and more than half felt comfortable with students. Some people cared for at the Athens hospitals are similarly inclined.

“Many patients feel like they’re getting better care,” said Steyer. “They feel like they get two doctors for the price of one.” Med students are not doctors yet, but they lend another attentive ear to patients.

However, more ears means more time in clinic for patients. On several occasions this fall, students went in to see a patient and were told,“ I’ve already done this,’” said internist Mary Bond, who coordinates medical clerkships for the school.

Most of the time, patients have to tell their story to the doctor and to the med student, Bond said, and “the duplication is probably one of the hardest things to get used to.”

For David Wells, a patient admitted for surgery at St. Mary’s, the time with the student only adds to the long day. “This is the seventh or eighth time today I’ve had to tell this story,” said Wells. “After twelve hours of this, it gets a little bothersome.”

Patients’ adjustment to seeing students is not lost on Bijal Vashi, a med student who spoke with Wells. “Some patients are just so miserable, they really don’t want to tell the same story again,” Vashi said during her internal medicine rotation.

On that same note, Dr. David Gaines, a Hospitalist at St. Mary’s and attendee for Vashi, has experienced similar reactions by patients. “It’s interview fatigue,” Gaines said.

Patients awaiting surgery are usually under heavy medication before they head to the operating room. All the while, they are asked question after question about their medical history.

Eventually this will be old hat, as it is for many thousands of patients accustomed to receiving care at teaching hospitals. What’s happening in Athens now is just the first step: next there will be fourth-year students in the hospitals as well, followed by residency programs for people who have earned their M.D. degree and are developing a specialty.

Emory University’s healthcare system trains more than 1,100 residents at any one time.  The residency program in Athens will be small by comparison, expected to have about 125 residency slots

As the same time, Northeast Georgia Medical Center in Gainesville and Gwinnett Medical Center in Duluth and Lawrenceville will launch residency programs with an additional 200 spots.

In the meantime, students are doing their best to establish meaningful relationships with their patients. “Patients are finding out that medical students have become a part of their life,” Steyer said.

When a patient he had helped care for in the hospital was moved to St. Mary’s Hospice House, one student –who was officially off duty – went and sat with the man until he drew his last breath, Steyer said. Soon afterwards, his widow phoned Steyer to express appreciation for the student’s actions. .

Other medical students pay extra visits because they hope to relieve some of the tedium associated with long hospital stays.

“I would go and just see them and see how they were doing for the rest of the day,” said Peter Karempelis, a third year student. Karempelis. “I think that kind of helps some of the patients who were a little more uncomfortable with having a student being in the room,” he said.

At the end of the day, Karempelis said, no one can force a patient to interact with medical students and some of them refuse.

“It can be frustrating at the beginning, but as long as you’ve got an open mind and can roll with whatever comes for the day, then you should be fine,” Karempelis said.

 

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