Making a Difference : One Hospital’s Approach: Put Doctors in the Patients’ Place

According to a recent American Medical Assn. survey, only 42% of patients thought that physicians explained things well to them. To help doctors improve their communication skills and develop patient empathy, Long Beach Memorial Medical Center has, since 1987, required each doctor in its family medicine residency program to spend one day and a night in the hospital as a patient. It’s thought to be the only such program in the nation.

HOW IT WORKS Residents are assigned false disease diagnoses plus some sort of false additional physical disability (such as a broken bone or hearing loss) and coached on how to pose as patients with these problems. They check in to Long Beach Memorial Hospital under aliases. To create the discomfort, isolation and loss of independence that most hospital patients experience, participants spend their time hooked up to intravenous drips, largely confined to their hospital beds and with diet and bathroom privileges restricted to fit their fictitious ailments. After their hospital stay, doctors even receive an itemized, albeit sham, bill.

RESULTS When doctors participating in the Resident Check-in program reported that it took as long as 45 minutes to be admitted into the hospital, Long Beach Memorial modified its admitting process. Currently, 98% of the hospital’s patients are admitted in no more than 20 minutes.

In a survey of 30 participants from 1987-1991: * BEFORE HOSPITALIZATION 53% said they did not understood what patients go through when they enter the hospital * AFTER HOSPITALIZATION 23% said they thought they still did not understand what patients go through when they enter the hospital * FIVE YEARS AFTER 73% said the experience caused them to alter aspects of their style of practice, including explaining fully why a medical test is done, allowing patients as many privileges and as regular a diet as possible, ordering foam egg-crate mattresses for patient comfort, letting patients know what time they make rounds and avoiding hallway discussions with medical personnel that might be overheard and misinterpreted by worried patients.

SAMPLE ADMISSION ASSIGNMENTS Pseudonym / False Physical Diagnosis / Admission Disability Lee Johnson / atypical chest pain / fractured shinbone Gary Wakatsuki / intractable back pain / pelvic traction Rajid Ramini / lower abdominal mass / corneal abrasion Roy Brown / blood ailment and gastritis/ hearing impairment Carrie White / acute pelvic pain / right knee strain

ONE DOCTOR’S EXPERIENCE DR. GRANT UBA: Family practice physician with Memorial Medical Group in Long Beach and 1987 participant in Resident Check-in “Going through Resident Check-In was the first time I was ever a hospital patient. I was admitted with a diagnosis of HIV disease. It gave me a lot of insight about what other health-care professionals do, how they interact with patients. As a physician, we go in, see a patient for 15 minutes in the morning, and then that might be all you see a patient for the day. Nurses and other professionals have a lot more contact; they explain what tests are being done, why they’re being done. They’re the intermediaries making the hospital stay as easy on the patient as possible. The program absolutely changed my perception of nursing and a nurse’s job. As a medical student I saw them only as people who carried out a doctor’s orders; as a patient I saw them as people who provided care and compassion to me and people who answered my questions. “Now I really try to explain to patients what’s happening. I encourage them to ask questions, to participate. If I order a test and they don’t know what the test is for, I want them to talk to me about it. When I was a patient, all I knew was that blood was being drawn; I didn’t know exactly what blood tests were being done. “Part of the sensitization and learning was getting a bill in the mail. I saw what the charges are. I encourage patients who have questions about their bills to bring them to me. In fact, I’ve brought disputed bills to the business office to help work things out for patients. “The Resident Check-in program was my introduction to the hospital and I really liked the way I was treated when I was admitted. The nurses were very compassionate, sensitive, attentive. Each of those little connections have influenced me in what I do now--including my decision to stay and be a part of the hospital and this community.

Sources: Long Beach Memorial Medical Center and Journal of American Board of Family Practice