November 22, 1996

Pathfinder Meeting- Questions and Answers

Continuing this week in the Reporter, VUMC leadership answers questions submitted by faculty and staff following the recent meetings outlining the institution's strategic direction.

This week's questions were answered by Dr. John S. Sergent, chief medical officer of Vanderbilt Medical Group, and Dr. John E. Chapman, Dean of the School of Medicine.

Is there a plan for establishing, or better advertising, a reference source of people and services available at Vanderbilt? Something like the Sourcebook listing of undergraduate teachers.

Sergent – Well, yes and no. In the past we have put out booklets with information regarding anything that anybody might conceivably want at Vanderbilt, and virtually all of them have wound up in trash cans. What we are doing is planning a total reorganization of our communication system, so that there would be a limited number of telephone operators for each clinical service. These people would be able to give out information, route calls to the appropriate places, and make appointments. Once this is in place, then a directory that groups services together, and therefore might be more easily utilized, would be a good idea.

Why is the Vanderbilt credo presented as something new instead of something that should have been done in the past and will continue?

Sergent – Because it really is a new way of thinking. While we individually give patients our total commitment, and we always have, the fact is that we have developed systems within departments which are designed to make our own jobs easier and more efficient. This sometimes leaves the patient out, resulting in multiple trips in order to get a single problem taken care of, difficulty with coordinating various activities, etc. By refocusing on the needs of the patient, as our first priority, we really are doing something new.

Unfortunately, health care has not really thought of a systems approach to managing its business, something that has been prevalent in American business for the last 20 or 30 years. By thinking of ourselves as a supplier, and our patients and the payers as customers, we will design systems based on their needs, and hopefully improve our service to them and our market share in the process.

When will our own insurance program cover Vanderbilt services such as cardiac rehabilitation, pulmonary rehabilitation, smoking cessation and high-risk weight management?

Sergent – The issue of what is covered by insurance and what is not is determined by marketplace factors, and not by me or anyone else. The fact is that if our insurance program covered these features, it would probably be priced out of the market. If all insurance programs begin to cover them, then ours certainly will.

Does the caregiver learn that the human condition requires personal involvement by the attending physician regarding the well being of the patient, and how to cope with a multitude of these demands by a "practice."

Sergent – An important part of the curriculum in both medicine and nursing includes is a holistic approach to the patient. Unfortunately, in the past, this did not often include much instruction in how to organize a practice in order to make it responsive to all the needs of the patient. We are working hard at ways to make Vanderbilt as a whole, in addition to the individual doctors and nurses, responsive to the needs of our patients.

It sounds great, but great patient care cannot take place until there is a return to old fashioned politeness and manners by physicians – because the residents and medical students copy their mentors. Bedside manner classes need to return as well, along with privacy sensitivity. There is a noisy party atmosphere among this group even in the face of trauma and calamity involving patients' lives and families.

Sergent – I agree totally.

Since the medical and nursing schools bring such a large financial burden on the money-making endeavors at VUMC, are there plans to try to get more grants and/or donations to cover this?

Chapman – I interpret this question to be based on the fact that medical education costs more than that provided through student tuition. Other sources of funding must therefore be achieved in order to fund the cost of medical education. Both of these observations are accurate. Cost shifting that provides what amounts to dual payment between research and education and between service and education is becoming more and more difficult as research support becomes harder to get and because regulations prevent cost shifting in relationship to clinical service. Research money is short and highly competitive, making cost shifting less and less feasible. Accordingly, some alternative source of funding of medical education must be found. Most feel that ad hoc funding through grants and donations will help and we are working hard in this area. A more sustaining, predictable income to support medical education will also be necessary. Funding may come from an "all payer" system or the so-called "sick tax" via health insurance or perhaps in other ways. Whatever the case, the current stress between and among service, education, and research efforts and funding of these will change. The funding of medical education has, to a measure, been funded in a "piggyback way" on research and service. A more comprehensive, more predictable and identifiable source of funding on a national basis is coming – with "strings" likely.

Any plans for the School of Medicine to include a switch to an accelerated six-year program?

Chapman – There are no current plans in the School of Medicine to include a change to an accelerated six year program.

Is there a liaison to this pathfinder group from the medical students? If not, I want to serve in that role.

Chapman – Medical students are constantly consulted commonly through the elected student leadership in relationship to various activities in the Medical Center so that student attitudes are tapped, student initiatives expressed and student interest kept closely in mind as planning takes place. A recent evaluation by the AAMC provides the information that Vanderbilt is number one among 125 medical schools in relationship to student satisfaction. A part of this satisfaction is due to student input. I note your willingness to serve in a liaison role with the pathfinder group and we will keep your name in clear focus as opportunities present themselves in relationship to student input.

My daughter's dream is to attend Vanderbilt University School of Medicine. Who can I contact regarding new financial help for her to attend?

Chapman – Financing a medical education is a major undertaking and we offer many opportunities for counseling. The principal person involved in financial aid, counseling, and related matters is Vicky Cagle, director of Student Financial Aid. Her office is in Light Hall.