Facilities, especially teaching hospitals, have to do more to promote awareness, study says
FRIDAY, Feb. 13 (HealthDay News) -- Most hospital patients cannot identify -- by name or role -- the doctors assigned to their care, a new case study of one urban hospital suggests.
"The majority of hospitalized patients we looked at were not able to name anybody in charge of their care," said study author Dr. Vineet Arora, associate program director at the University of Chicago's internal medicine residency program. "And when they did name somebody, they got it wrong, incorrectly naming their primary care physician or some specialist. This reflects the fact that patients are seen by a lot of different doctors and teams, and they may simply not know who's in charge of their care."
"Of course," Arora added, "it's hard to know how generalizable this is, as we only looked at one institution. But I suspect that the findings are probably reflective of the current situation at a lot of urban teaching hospitals."
The authors noted that the institution used for the new study, the University of Chicago, is what's known as a "teaching hospital." Such hospitals "not only care for patients but also train the students and residents who are there under the supervision of a board-certified faculty physician," Arora explained.
Patients in teaching hospitals are typically attended to by larger teams of caretakers than at non-teaching hospitals. And Arora said that handoffs among assorted teams of health-care providers -- including physicians, interns, sub-interns, fellows, attending residents and medical students -- can present incoming patients with a "confusing environment."
For the study, Arora and her colleagues interviewed 2,807 people admitted to the inpatient general medicine service at the University of Chicago in 2005 and 2006. Three-quarters of those surveyed were unable to name anyone in charge of their care. Of those who gave at least one possible name, 60 percent gave an incorrect answer.
Yet, 56 percent of the patients said their understanding of their doctor's role was either "very good" or "excellent."
The University of Chicago team reported its findings in a research letter published in the Jan. 26 issue of the Archives of Internal Medicine.
A number of factors -- both patient-related and hospital-related -- seemed to influence a patient's inability to identify caretakers. Blacks, the elderly, those with less than a high school education and unmarried people had more difficulty identifying their physicians. Also, people admitted in an emergency room setting or at night by a graveyard shift (or "floating" team) were less likely to be able to identify their caregivers, the study found.
Still, 64 percent of the 1,901 patients who participated in a follow-up interview a month after being released from the hospital said they were "very satisfied" with their doctors.
The study authors said that teaching hospitals should nonetheless devote more attention to improving patient awareness of their caretaking team and the roles played by individual physicians.
"I'm a medical educator -- I teach students and residents," Arora said. "And I think it's important that we teach them to actively introduce themselves in a way that patients can understand what their role is."
But patients should also act to empower themselves by taking a proactive approach to identify those caring for them, she said.
She noted that some states have made a concerted effort to help patients in this way. The Lewis Blackman Hospital Patient Safety Act in South Carolina, for instance, mandates that "all clinical staff, clinical trainees, medical students, interns and resident physicians of a hospital shall wear badges clearly stating their names, their departments and their job or trainee titles -- in terms or abbreviations reasonably understandable to the average person."
But, one expert suggested that such consumer-friendly steps aren't enough, and that the responsibility for addressing the problem lies with medical professionals -- not patients.
"So the hospital staff -- and that means the doctors, the nurses, the residents and even the guy who cleans the room -- simply has to explain to patients again and again and again who they are and what their role is, whenever they go into the room," said Dr. Herbert Cushing, chief medical officer of Indiana University Hospital, which is a teaching hospital, and associate dean of student affairs at the university's School of Medicine.
The American Academy of Family Physicians has tips for talking with your doctor.
SOURCES: Vineet Arora, M.D., M.A., assistant professor, department of medicine, and associate program director, residency program, internal medicine, University of Chicago; Herbert Cushing, M.D., chief medical officer, Indiana University Hospital, and associate dean, student affairs, Indiana University School of Medicine; Jan. 26, 2009, Archives of Internal Medicine
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