"Teaching" hospitals

[Karen]

Quite often in these posts is a suggestion to go to a "teaching hospital" for a definitive answer and/or treatment for various problems. I actually have a bit of skepticism with regards to going to a hospital where one of the purposes is to allow medical students an opportunity to learn and ACQUIRE the skills for diagnostics and surgery. Although I lived out of state, I came to the LDS Hospital in Salt Lake City for my coarctation surgery in 1967. My daughter is an RN at that hospital and tells me that it is THE place in the region for heart valve replacement surgeries. (My husband's aunt has also had one pig valve and 3 mechanical valve surgeries at LDS Hospital in the past 25 years). However, my current insurance would require me to go to a surgeon at the University of Utah Hospital. I know that medical students need to "practice" somewhere before they are operating (literally) on their own, but I really don't want to be someone's guinea pig when the time comes for valve surgery. On a side note, I checked out the experience of the surgeons at LDS, and the one who lists valve replacement as his special interest clinically graduated from the University of Utah only 7 years ago. The cardio-thoracic surgeon that my daughter personally would recommend (and also recommended by her 2 "favorite" cardiologists) isn't even on the list for specializing in valve replacements. 'Just curious how the "system" works, and why it is such an advantage to go to a teaching hospital...

Karen

 

[sue943]

I can't talk for the American teaching hospital system but have experience of NHS teaching hospitals in the UK.

Students are not permitted to treat patients, although I did sometimes have some senior students taking my blood for tests, rather than a phlebotomist when I had my heart block. Mostly students just observe and accompany senior doctors, they don't 'practice'. You will not be a guinea pig, they are not going to participate in your surgery. Teaching hospitals normally have eminent doctors on their staff, so you normally end up with superior care.

When I had endocarditis I was in St George's Hospital in London and it is not only a very good teaching hospital but is a centre of excellence for cardiac problems. The medical school is very large. The students normally 'hunted in pairs', they would come to my bed and ask my permission to have a listen to my heart and feel my pulse. I had every right to refuse and there would be no problem. I didn't refuse to let them listen, one day they will have patients with my problems and will have gained vital experience from listening to my heart. They took my medical history and I gave them all the help that I could. At all times they were very respectful, and very grateful to me for allowing them to gain experience.

Students have to learn and if everyone refused to be examined by students (as well as by fully qualified doctors) then we will end up with lots of very inexperienced new doctors. The students do not replace the experienced doctors, they supplement them, you get more attention, not less.

My son-in-laws is a doctor so I felt it my duty to assist other future doctors.

 

[Tom F.]

It was my experience that the large teachiing hospital where I had my surgery, Rush University, offered me several surgical options which were unavailable when I went to a large community hospital. My problem was an ascending aortic aneurysm, and at Rush I had that problem fixed but retained my own valve. Valve sparing procedures were not offered out in the chicago burbs.

Having said that, there are differences between one teaching hospital and the next. You need to do your homework. The most important thing is to find the right surgeon.

Finally, when it came to the surgery no student did anything but watch, I asked, because I had the same concerns.

 

[Phyllis]

Teaching hospitals affiliated with great universities are usually where you find the "star" surgeons and most up to date procedures. The important thing is to research and find the most experienced surgeon for you procedure and I agree, you can request that the surgeon you decide on does the procedure. Our experience at Brigham was that the "students" mainly did the post-op checking, but Dr. Cohn was there for the most "important" part.

 

[Barbara Stewart]

Teaching hospitals

Teaching hospitals

Karen,
I've had two ohs in the last year. One in a "Heart Hospital" in the community and the second in a teaching hospital in a major heart center. THe difference was profound. The replacement of my valve didn't hold the first time and I got MSRA, one of those horrible antibotic resistant infections. THAT is what made me so sick.

In HOuston, at the teaching hospital, where the founder and namesake for the building still does rounds every morning, they seemed completely on top of everything. I did get a kidney infection, but they treated it quickly. I would go back there in a heart beat. If you possibly can go to a teaching hospital, do it. The most up to date methods and the best surgeons are there.

Barbara

 

[TomS]

Funny thing. After my AVR I got a job as the head of marketing for a regional teaching hospital. Here's the deal.
They tend to attract better surgeons because the Doc also gets to be "professor of cardiothorasic surgery", or something similar, and they are pushed by smart students to understand and lead in cutting edge techniques. This is a good thiing, because "cutting edge" means "improved" ways of doing things. So, the net of it is that you end up with better Doc's using the best technique's.
The downside is that there are students there, and they will either play a part in the operation (may play a part), or will be hanging around your room. The three things that I've learned since my surgery which I wished I knew before are:
1. Don't be afraid of going to a teaching hospital but make sure you set the rules, which are:
2. Don't sign anything that says that anyone other than a board certified physician will do anything to you. It is completely OK and your right to make that demand.
3. Toss the students out of your room post-op. The more people in your room, the more chance for infections. There's no reason to let them in, unless you are feeling up to company.
With these precautions, you'll be making a good choice with a teaching hospital.
Good luck,
Tom

 

[Karen]

Thanks to all of you for your responses. They have been very reassuring and make a lot of sense. My cardiologist was on staff at the University of Utah until the end of last year. When I talked with someone at the Adult Congenital Heart Disease clinic a few weeks ago, she said my cardio has an excellent relationship with their surgeons. I am sure that when the time comes, he'll be able to make some good recommendations...

By the way, and a little off subject, I had contacted the ACHD clinic at the University of Utah in response to Marguerite's suggestion that our children might be screened for BAV at a teaching hospital etc. The nurse that I talked to -- the one who specializes in congenital valve problems -- told me that the clinic recommends screening only if there are symptoms present. She said they WOULD do it just for the peace of mind of those involved, if desired. But that it would be very wise to have life insurance policies on the kids BEFORE the testing. But none of it would be "free" and as part of any studies by the University. All of this comes back to what my own conclusions had been. One of our eight children (and one granddaughter) have been screened. Hopefully the others will be one day.

It was interesting to learn that the cardiologist that diagnosed my coarctation 40 years ago was one of two cardiologists that founded this ACHD clinic almost 30 years ago. I do feel like I have good resources here to follow my little problem...

Thanks again!
Karen

 

[tantekay]

just my experience

just my experience

My son was born with a farily complex congenital heart defect. When it came to surgery -- we had two major hospitals to consider, insurance would accept both. However, one was out of state, but still only 3 hours away. The other was in state an only 2 hours away (and bonus - only 1 hour from my parents.) We chose the instate hospital which happened to be UVA. I found that our expeience there was wonderful. We did have some students that came in to look at our son, listen to his heart - specifically the murmur and the shunt that was put in. I learned a tremendous amount as well. I was the parent that questioned just about everything, and when I wasn't too sure -- I'd ask several different docs to see what the general opinion was. Our surgeon also had a resident (or was it a fellow surgeon) that was studying pediatric cardiothorasic surgery. We do know that he was in the surgery and assisted our surgeon. But I don't think I would have changed anything. It was truly a learning experience for the doctors my husband and myself. As for what your hearing about the latest procedures and up to date info. I can say that is true as well. Our surgeon had studied and worked with his mentor on a modified norwood. From the info I've found, he was the first to bring this new technique to Va in the fall of 2002 and our son had his first surgery in August of 2003 -- so very up to date and doing what was not only best just to get us through the first surgery, but planning the surgeries to get the best outcome down the road. To sum it up -- they could have done a pulomnary band and solved things for the time and waited until he was older for major surgery, but they chose to do a bigger surgery first so that it would save the ventricle any undue stress and not cause the wall to thicken and cause him more problems when they had to do the next surgeries. I hope this helps a little and doesn't make things any more confusing. Best of luck in whatever you choose.