Restoring trust in VA health care.

295 But when Mrs. A. answers my question why, she doesn’t mention teaching material or guinea pigs. She doesn’t dread amateurish invasions of her privacy or the frustration of answering the same questions again and again. She doesn’t allude to dark rumors about unsupervised residents run amok. She talks about her late husband’s final hospitalization at another academic center. There, she heard often about Mr. A.’s team of doctors, but she never saw them all together. When an intern or student or senior physician popped in, he or she usually came alone and was always in a hurry. Mrs. A. couldn’t tell whether they talked to each other because often one didn’t know what another one did. And each time her husband needed help at night, a different stranger came. I transfer Mrs. A. to the nonteaching service, wishing her well. I don’t tell her how my team conducts itself here, so differently from what she saw elsewhere. My residents and I will go off service tomorrow, our 4-week rotation over, and I can’t promise that the new team will run their show as we run ours. Nor can I promise that the nonteaching service will satisfy her more. After all, her aversion to the teaching service has nothing to do with teaching. But tomorrow, other patients will ask more pointed questions. Having embraced patient-centeredness with gusto, they’ll want to know how clinical teaching benefits them. How should I answer? Will I say that clinical teaching, like its subject matter, is more art than science (and thus lacks gravitas in academic centers today)? Will I admit that this art dances to different drummers (no two teachers teach alike) refereed by recondite rules (no one teacher inarguably better or worse than another)? Will I claim that these are strengths, not weaknesses, and that effective clinical teaching is all about listening (hard to measure), adaptability (hard to judge), and impromptu exploitation of “teachable moments” (hard to plan)?5 And after we’ve had our mature dialogue, will these patients buy my assertions? Or will my customers be a hard sell? Learning hospitals would do well to learn more about these things. Disclosure forms provided by the author are available with the full text of this article at NEJM.org.