A new book is out, entitled “The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital.” The author, Alexandra Robbins, spent four years interviewing nurses to find out their perspectives on our health care system. Some of her conclusions are ones that are well-known to those who work in, or with, our medical system.
If you want to know which doctor to see, ask a nurse who has worked with the doctors you are considering. If you want to know how a hospital treats its patients, don’t ask a doctor, ask a nurse instead. Do patients who are wealthy or well-connected get better treatment? The book notes that many hospitals have different rooms, and sometimes even different floors, where the affluent and influential patients receive better, or at least more comfortable, care than ordinary people.
One of the conclusions, however, is one that the public likely does know about: don’t get sick in July. It’s not because of the heat, or vacation schedules, it’s because the “residents” start their two or three year shift of specialized training on July 1 of each year. If you go to a teaching hospital, such as the U.W., Swedish, or Children’s, much of the care will be provided by residents. That’s how teaching hospitals teach new doctors. That’s why, in such hospitals, there is often a gaggle of young doctors accompanying your doctor when he visits you at the bedside.
A resident is a real doctor who has received his/her medical degree, but the residency is to provide additional training in the specialty chosen by the new doctor, e.g., internal medicine, obstetrics, or urology. But the residents also “rotate” through different specialties, for short periods of time, so they get a broader picture of the medical system in which they will work. So the resident doctor who examines your prostate or does a vaginal exam may be an orthopedic doctor-in-training.
The problem, as the book points out, is that the new doctors often don’t know what they do not know, and are reluctant to ask nurses or other “lesser” care providers for help. And they are also reluctant to ask the attending doctor for fear this will reflect badly on them.
This changeover in residents has been tied to increases in medical errors, medication mistakes, length of hospital stays, and even death rates. In England, the shift change occurs in August of each year, and some doctors call if the “August Killing Season.” So if you get sick enough to be admitted to a major hospital and have some choices as to time of admission, make it later in the year instead of July.
