Tuesday, November 29, 2011

Tip #7: Know Your Doctors: A Short Guide to Hierarchy! ~ More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Who are all these people who introduce themselves as doctors in the hospital?  Here is a short guide to what each title means:  

Attendings:  These are the most senior physicians.  In a teaching hospital they are in charge of the fellows, residents, interns, "observers" & medical students. 
  • All of the junior physicians are operating under this doctor's license as most of the fellows/residents/interns have their MD or DO but do not have their license.  Therefore the attending tends to oversea the teams work to make sure it is safe & also spends a lot of time using patients to teach the junior physicians.  
  • You will not see the attending physician very often except usually briefly on morning rounds with the whole team.  
  • They tend to not be aggressively involved in patients care because they want to train the fellows & residents to make independent clinical decisions under their oversight. 
  • The attending often only knows what the resident presents to the team--so make sure that your resident gets all the details on your condition so they can present your case as accurately as possible to get the BEST guidance (and the BEST care for you!)  That said, when the attending rounds in your room in the morning & you don't hear him or her mention your most concerning issue than absolutely bring it up--it may not have gotten included in the resident's presentation.
  •  In the operating room, the attending usually either does the most challenging part of a procedure or carefully oversees the fellow/resident's surgeries & the PAs/NPs.
Fellows:  These are M.D.'s or D.O.'s who have completed their residency & are now going for an additional level of training in a very specialized area. 
  • For example, in my field, when you finish residency you can become a "board certified Physical Medicine & Rehabilitation" doctor.  But if you want to do interventional pain, then you need to do an accredited fellowship to become "Board-Certified" in Pain!
  • Most of them are licensed in the state they practice in.
Residents:  These are the people most involved in your daily care.  They are junior physicians, M.D.'s & D.O's at approximately 2-6 years out of medical school. Their job is to learn to be an independent clinician.
  • The attending physician is usually a hands off supervisor unless safety is involved.  This is to try to teach them as much independent clinical decision making as possible.
  • They are often the closest line to the attending physician but more importantly, these people are responsible for managing all your daily orders, your admission, your discharge & your medications. If they have interns under them, than they supervise the intern's executions of these activities.
  • They usually lead a team of interns and other junior residents (if they are past 2nd year). 
  • At night they will often be totally on their own at the hospital--no senior physician is in-house.  They can call the attending if a major crisis occurs but this is relatively rare.
  • They generally RUN the codes (when a person has a cardiac arrest or is found unresponsive, etc
  • They are on call frequently (this means that they spent the night in a small bed in the hospital & may or may not have gotten any sleep depending on the specialty)  and may seem quite tired.  Be patient with them when this appears to be the case.
Interns:  First year doctors.  The worker bees.  Their job is to do all the paperwork associated with your admission & discharge:  orders, prescriptions, etc. AND simultaneously be learning as much as possible.
  • They will usually be the ones to write your admission note, your daily progress notes and your discharge summary.  
  • They will usually be the first person to your bed in a crisis or code.  
  • They are generally awake all night long when they are on call & take turns covering nearly all the patients in the hospital. 
  • They will be the first person you see in the morning & the last person you see at night.  
Medical Students:  These are "doctors-in-training" and should introduce themselves as such even if the staff addresses them as doctor (as I was addressed during my training).  
  • They will usually manage the daily notes for 1-5 patients under the supervision of the resident & intern.  
  • They should NEVER be the only person who examines you daily and if this happens, make SURE that the resident & intern & even the attending know that the student is being allowed or told to operate independently as if they are a doctor.  
  • Third year medical students are in their first year of clinical exposure.  
  • Fourth year medical students are in their last year of training & should be preparing for intern-level responsibilities.
Ok! That should be everyone!  Hope this helps!

Coming Up on Next Week's Medical System Tuesday
  • Tip #8 For The Best Hospital Care:  Be Nice ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~ 

Coming Up THIS Week!
  • SuperImmunity Foods for KIDS (Calling All PARENTS!)
  • RECIPES & Ideas: Snacks!  YUMMY & Portable Plant-Based Snack Food--all sugar-free, gluten-free & without adding oil or fat!!

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