Do You Always Need the Mayo Clinic?

Understand the critical difference between teaching and non-teaching hospitals

Posted Feb 16, 2015

When I was a surgeon in academic (teaching) medical centers, I used to feel sorry for patients who had appendicitis, hernias, gallbladder disease, and other common and (medically speaking) straightforward illnesses.

When I was a surgeon in non-teaching community hospitals, I used to feel sorry for patients who had pancreatic cancer, bleeding esophageal varices (veins) secondary to liver cirrhosis, and other less common and (medically speaking) complex illnesses.

If you are truly to “Own Your Health” and play a major role in protecting and maintaining your health, you should understand a basic difference (albeit generalization) between academic (teaching) and non-academic (non-teaching) hospitals, as understanding how these two care environments differ can impact you should you ever require hospitalization.  Of course, if you need true emergency care for an immediate life-threatening illness (heart attack, stroke, etc.), the responding paramedics or EMTs will likely follow protocols and select your hospital.  However, even for emergency room care, let alone when you are being admitted to a hospital electively (non-emergently), you may well be able to choose what type of medical facility you wish to enter.

Academic medical centers teach medical students and, often, nursing students, pharmacy students, nutrition students, and other students, about human diseases and how to care for patients.  The Mayo Clinic, Stanford University, the Cleveland Clinic, the University of Chicago, and hundreds more (both universities and private) are scattered across the country.  Being hospitalized as a patient in an academic center is exhausting.  You come with worsening belly pain to the emergency room, where first the third-year medical student takes an extensive history (including asking about every disease in every distant relative you can remember) and then performs a total body physical exam (pushing on every inch of your body).  Next, the intern takes your medical history and then performs a physical exam.  Then the resident takes your history and performs a physical exam.  And finally, the attending (senior) ER physician takes your history and performs a physical exam.  Now, as you work your way up the experience ladder, the history becomes shorter (as the more seasoned questioners select more targeted questions) and the physical exam becomes more limited (as the more seasoned examiners focus on the physical areas of interest).  Still, telling person after person how the pain began around your belly button and then moved down to the bottom right of your belly, and having person after person push on that increasingly painful spot, can get really old really fast.

But wait…you’re not done.  In fact, the entire student-intern-resident-senior physician evaluation is repeated when you’re admitted from the ER to the surgical ward.  It’s not uncommon for an academic hospital patient to share his or her history and be poked and prodded six or eight times before any definitive treatment even begins.

However, if you’re that same patient in a non-teaching community hospital, chances are you’ll only tell your story (abbreviated, as guided by the targeted questions of an experienced physician) and be examined (a limited, targeted exam) twice:  once by the ER physician and then by the surgeon.  No student pressing on every spot on your body.  No intern asking yet again if anyone in your family ever had diabetes.  Fast and focused.

And in the end, you’ll be diagnosed with acute appendicitis in both the academic and community hospital, and you’ll rapidly be cured through the same surgical procedure, with the same good outcome.

That’s why I used to feel sorry for patients with simple, straightforward illness who were hospitalized in academic medical centers.  The repeated probing questions.  The repeated probing fingers.  All so students and young doctors could learn about simple appendicitis, and all with no measurable benefit to the patient.

But while I felt sorry for teaching hospital inpatients with simple illnesses, I felt far sorrier for patients with complex and rare conditions who ended up in non-academic hospitals.  I have seen many community hospital patients suffer complications, prolonged hospitalizations, and even death when, if cared for in academic centers, constantly surrounded by inquisitive, eager students, interns, and residents in an environment committed to continuous teaching and learning, they would have suffered less and even survived.  Because my experience convinces me that for truly challenging patients (patients with multiple medical conditions and/or complex and unusual diseases), the constant presence of young minds seeking to learn, young caregivers overly eager to help the sick, results in better care.  Students and interns and residents are always around their patients, examining and re-examining them, talking with family members, sitting at all hours by the bedside and observing their charges, reviewing and re-reviewing lab results.  And students and interns and residents are constantly reading, trying to better understand the pathology that their patients are exhibiting.

More than once has a student or intern or resident on my surgical service found a key piece of information that significantly helped in the care of our patient.  It is in this academic environment that a patient with kidney failure and holes spilling caustic intestinal juices onto the skin of the belly (enterocutaneous fistulae) has the best chance of making it through a surgical removal of an infected knee prosthesis (an actual case); where a man with esophageal cancer eroding into his trachea (breathing tube) is most likely to survive operative treatment (an actual case); where a construction worker who, while working high on cocaine, drove his circular saw through his body, slicing numerous critical organs, is most likely to eventually walk out of the hospital (an actual case).  I have seen these and many, many more patients with complex medical conditions survive in large part due to the constant probing and poking and prodding and questioning and observing of medical students, nursing students, pharmacy students, nutrition students, interns, and residents.

Now, before you swear off non-teaching hospitals forever, understand a couple of important facts.  First of all, I am providing generalizations.  While community hospitals are primarily experienced in the care of common and less complex medical conditions, many non-teaching hospitals also have tremendous experience in caring for certain specific complex conditions (heart disease being a common example).  And again, for straightforward illnesses, being admitted to a non-teaching facility will likely result in the same favorable treatment and outcome without all the additional exhausting interactions you would experience in a teaching institution.  So if you are a relatively healthy person (that is, you don’t suffer from multiple chronic medical conditions), and if you suspect or know you’re suffering from a common condition (hernia, atrial fibrillation, uterine fibroids), you may just want the simplicity and ease of a non-teaching hospital.  However, if you have multiple underlying chronic or complex medical conditions, and/or if you suspect you have an uncommon or complex illness, you should recognize that all of those students, all of those repeated questions, all of those examining hands…they’re an investment in your health.

And finally, if you are admitted to a non-teaching hospital and become concerned that things are not heading the right way, make some noise and ask for (and, if necessary, demand) a transfer to the nearest academic center.  Remember, if you don’t push for it, it is unlikely that anyone else will.  It’s your health and your life.