Yesterday’s post of the testimony of Dr. David Smith, president of SUNY Upstate Medical University, brought two particular responses that clarified my thinking about what’s wrong with Upstate Medical University/Hospital.
First, there was a message from a friend who is a professor at Upstate Medical University (yes, I actually have friends in the medical system). She let out an aggravated “yipe!” and asked, “What is terrible about our health care delivery here in Central New York? I know most of us work extremely hard to deliver the best education we can to future health professionals. . . So, what’s your beef?”
Second, I heard from another friend who is a patient at Upstate University Hospital. She has a colonostomy and something’s wrong so she was sent for x-rays. They gave her something to drink and then planned to take x-rays as the stuff moved through her system. Problem was, the stuff wasn’t moving fast enough so she had to get off the table and wait in the hall.
My friend is in her seventies and is all bone and nerves with virtually no protective body fat. The x-ray folk did not help her get off the table. They left her to flail around, striking vulnerable body parts on cold metal projectiles. Then they left her shivering in the hallway clad only in a hospital gown and sitting on a hard plastic chair while they moved on to another patient. They repeated this process four times over a two-hour period.
“Dr. Smith said . . . they are primarily here as a university, what drives their mission is education and research . . .” Patient care is not included. Upstate Medical University/Hospital is doing research, teaching and patient care, and those three things require different skills, different resources, and different priorities.
- I was treated by an Upstate physician who totally botched my care. The physician who straightened me out said that the first doctor was a brilliant researcher—and shouldn’t be allowed within ten miles of a patient.
- Another Upstate physician—who repeatedly failed to follow up on my case—said that he really loved teaching but in order to maintain his teaching position at Upstate Medical University he is required to put in a certain number of hours in patient care. He didn’t want to.
- I found a really good clinician at Upstate Hospital but couldn’t get follow-up appointments with her because she only sees patients one half-day a week. That’s not a doctor—that’s a teacher-administrator.
- A doctor admitted me to the hospital as a research subject and provided the definitive diagnosis of a rare disease. He was the only doctor for miles around who knew the correct treatment but he would not treat because he was only doing research. I refused to vacate the bed; in order to get me to leave, he lied about what follow-up he would provide.
I do not have the background or breadth of experience to evaluate Upstate’s quality in research and teaching but I for damn sure do know about their patient care, having first become a patient at Upstate in 1966, and I am here to tell you that Upstate does not provide quality patient care. One of the things that means is that they are teaching their students poor patient care.
What Upstate is teaching their student physicians is medicine: the use of machines, tests, computers and drugs. What they are not teaching is human care: respect, empathy and compassion. They are teaching how to treat diseases, not people.
Note Dr. Smith’s comments, as quoted in the Legislature’s minutes:
- Mission: teaching, research and service – it is a university with a hospital attached. They have a campus in Binghamton, opened a set of classrooms at Jefferson Community College in Watertown and have affiliations throughout the region. [teaching]
- Multi-dimensional growth – to be regionally responsive – growing enrollment (about 30%), growing research mission (19% this year) . . . [teaching and research]
- . . . realized 16% growth in clinical revenue this year, research goal was 10% – realized 19% this year . . . [research over treatment]
- If they are going to continue to hit the mark of 5% annualized growth, they will have to have access to additional beds . . . According to their strategic plan, they need access to about 110 additional beds. With enrollment and faculty growth, they will need approximately 540 total bed access . . . [growth is for the purpose of education and training, not treatment]
Dr. Smith is running a university to teach students to diagnosis and treat illness, not a hospital to diagnose and treat patients. There’s a big difference. For example, Upstate has no maternity unit because, as a doctor told me, “If you’ve done one delivery, you’ve done them all. There’s nothing to teach.” I have long maintained that if white mice had molars, Upstate would not have a dental clinic. We are not sick people in Upstate’s system: we are teaching and research subjects.
Teaching and research are not incompatible with one another; patient care is. Upstate Medical University should disaffiliate with Upstate University Hospital. The hospital should be run by an executive whose sole focus is providing good patient care. Then Upstate Medical University should contract with Upstate University Hospital (which should delete “University” from its name) to provide clinical experience for its medical students.
Let patient care be for the patients! As it is, we are repeatedly told by Upstate staffers, “We’re here to train doctors.” And don’t us patients just know it! In the circle of focus at Upstate the student is in the center, not the patient, consequently students are being taught their own importance. They go out into the community with the unquestioned certitude that the patients exists to serve the doctor’s needs, not vice versa.
My last appointment at Upstate consisted of waiting, then being seen by a nurse. Waiting, and then being seen by a resident, who did not do an accurate job of interviewing me. After waiting some more, the professor entered the room. His focus was on the resident; he barely looked at me. The message was very clear: he was there to teach the student, not to treat the patient.
Five months later, I’m still waiting for an appointment to get the results of the tests that were ordered that day. However, Upstate has billed Medicare about $500 for services rendered. Do you, the taxpayer, think you got your money’s worth? Are you satisfied with the human service provided to me and billed to you?
And, more important, when it’s your turn, are these the doctors you want to treat you?