Teaching physicians to be patient: a hospital admission experience for family practice residents

A program has been developed to sensitize physicians to the discomforts, uncertainties, and anxieties experienced by patients on admission to the hospital, so that greater empathy and increased communication can be fostered with their own hospitalized patients.

For the last 5 years, all incoming family medicine residents at Long Beach, California, Memorial Medical Center have been admitted incognito to the hospital during their first day in the residency. Hospitalized residents are assigned an admission diagnosis and an associated disability, given a pseudonym, and provided with fabricated insurance information (by the hospital administration) to facilitate their admission. Each incoming group of 6 residents is admitted over the course of an afternoon and evening and discharged the next morning. Residents evaluated the admission experience by means of before-and-after questionnaires. They and residency graduates also responded to a follow-up survey instrument that asked participants to assess the program's long-term educational impact (response rate, 100 percent; n = 30).

Although the program is carried out annually, we have been able to admit the residents to this large (998 beds) medical center typically without their identities being discovered, resulting in a realistic educational experience. While diagnoses are contrived, the discomforts are real, and participants become acutely aware of the loneliness, pain (e.g., from intravenous lines), and uncertainty experienced by patients. Long-term effects on day-to-day practice attributed to the program by residents and graduates include minimizing orders for nonessential tests and middle-of-the-night examinations and keeping patients well-informed (especially letting them know when they will be seen by the physician).

The effort, logistical problems, and costs associated with hospitalization of incoming residents disguised as patients appear to be offset by the admission program's long-term impact on participants' sensitivity regarding experiences undergone by hospitalized patients and their awareness of their role in helping to ameliorate discomforts associated with hospital admission. Strong support from the hospital administration, however, is essential to the success of this type of program.