Tip #10 For The Best Hospital Care: Try Not To Be Alone ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Today we are concluding the series on How To Get The BEST Medical Care In The Hospital:  Insider Tips!  As always, this post is written to "you" but it can be equally applied to any family member or loved one. 


Tip#10:  Try Not to Be Alone!


The best piece of advice that I can give you is if you are sick enough to stay more than one night at the hospital, try to never be alone for long periods of time.  Try to have family members, friends, etc with you as close to around the clock as possible.  Don't have them come visit in a big group--that is a waste because their visits are more helpful if they spread out and give you coverage for longer periods of time.  Have them visit in small trickles throughout the day (and night for that matter).  

One way to spread a stream of visitors out is to explain the importance of shifts to everyone, have a point person volunteer and actually set up an email list or formal schedule for people.  This is what my own family did when my family member was in the hospital last month (the event that inspired me to write this series!) Unfortunately we as a family have had many hospitalizations & over time, creating a visitor scheduling system has become routine.

By making a formal schedule, it allowed my family member not to be alone & allowed each of us family members to manage our personal lives & keep working.  Important caveat--the family should actively encourage your primary caretaker (husband, daughter/son, parent) to try to minimize the time they need to spend at the hospital.  While you are in the hospital, it is an important opportunity to give your spouse or child or parent a good rest before you come home & they will be responsible for your care.  So ask for help from your church, synagogue, mosque, spiritual center, social club or network of friends instead.  Try to arrange to have someone looking in on you about every 2-3 hours.  

I recommend that you keep a notebook in the room that all the visitors should use to write down important things--like what doctors come into the room, any procedures that you get taken to, or anything nursing says that would be important to pass on to the next visitor (i.e.--nurse:  we need to keep an eye on her constipation.  You write down: f/u constipation.  Then the next person looks at the notes and sees they should remind you to ask the nurse about the plan for reducing your constipation).  My father has frequently been very ill--I have a large family & we practice this technique when he is in the hospital since we literally take turns sitting bedside & the notebook allows us to share what the doctor said on the first person's visiting shift so the last person's visiting shift knows what is going on! 

The notebook should have all important info clipped to it inside the front cover--like who your doctors are AND your Medical Info Sheet that we discussed here in Tip #4!

If you have a large enough family or friends and you feel comfortable asking, I encourage you to see if its possible to have one of them take turns spending the night.  


If you can't get anyone, and you are pretty sick than hiring a private-duty aide to sit with you during the night is worth the investment if you can afford it.  


If you are a family member caring for an elderly patient susceptible to dementia or confusion than I can't encourage you strongly enough to hire someone if you possibly can!! That aide however is not paid to watch TV--they are paid to let you sleep quietly, check on how you are doing, re-orient you to reality calmly and GENTLY if you are confused & be the family's eyes and ears.  Sometimes it is not possible to have someone stay over but I would lobby hard (AND BE VERY VERY NICE when asking) if it isn't usual hospital policy.

Remind everyone that you need to rest and your visitor point-person should emphasize this as well.  A hospital is for healing, not a party.  Please be respectful of other patient's needs as well. The point person should suggest that people bring a book or magazine to read, a laptop, a musical device with headphones, etc so you don't need to talk for most of the visit.  While they are in your room they shouldn't be talking on their cell phone or making a lot of noise.  Their purpose is to give you the gift of their time to help staff caring for you be able to perform to the best of their abilities.   

***KEY:  Do not allow visitors to interrupt the hospital routine.  When the nurse comes in to give you your meds, change your wound dressing, give you an enema or any other indelicate thing that your really don't want your family or friends to see, do NOT tell the nurse to "come back later."  You have to be a teammate remember--keep them on schedule & it will be to YOUR benefit-- you'd be surprised how many things about your care get missed as they are passed on to the next nursing shift if the nurse wasn't able to execute your care on schedule!***

See here for questions that your visitors should remind you to ask staff EVERY DAY & things to bring to staff attention.  Always remind who ever comes that it is critical they behave politely and respectfully towards staff members (see my post Tip #8).  To behave otherwise WILL reflect on you and affect your care. Remind your visitors that the staff is very busy and has other patients in addition to you.  If the visitor can safely & comfortably do a task for you--i.e. get you a washcloth and help you wash your face, pass you your urinal & dispose of the results, etc--than they will endear themselves to the staff to no end! 

That said however, don't let staff disappear on you just because you have someone in your room (it happens sometimes, especially if you are a family member & a healthcare person like me or my husband).  If you have waited a reasonable amount of time for a nurse/tech to respond (15 mins or so) and no one has come, then send your visitor to the main desk to ask for assistance. (Visitor Tip:  just standing at the nurses station can be quite a motivator for the administrative assistant or other nurses--wait there in full view until someone comes to assist your loved one..)  In fact, I recommend sending your visitor to the desk for help first instead of you buzzing your call light, but either method is ok. 


Ok!  This concludes this Tip AND this series!!  I hope that this series will help you and your loved ones get outstanding care & make you feel empowered with understanding about how hospitals work.  


It has been a pleasure to share this information with you--please update me in the comments if you have used these techniques & let me know whether they work for you & your family!!


Here are all the previous posts in this series:  

Tip #1: Be a Teammate & Tip #2: Be concise & organized: http://happyrehabdoc.blogspot.com/2011/11/how-to-get-best-medical-care-insider.html

Tip #3:  Key Questions to Ask Your Doctor: http://happyrehabdoc.blogspot.com/2011/11/tip-3-key-question-to-ask-doctor-in.html

Tip #4:  Know Yourself--How to Make a Medical Info Sheet:  http://happyrehabdoc.blogspot.com/2011/11/tip-4-key-things-you-need-to-know-about.html

Tip #5: Know the Hospital Routine: http://happyrehabdoc.blogspot.com/2011/11/tip-5-what-is-hospital-routine-part-4a.html

Tip #6:  Know the Role Everyone Plays in the Health Care Team: http://happyrehabdoc.blogspot.com/2011/11/tip-6-know-role-that-each-person-plays.html

Tip #7:  Know Your Doctors: http://happyrehabdoc.blogspot.com/2011/11/tip-7-know-your-doctors-short-guide-to.html

Tip #8:  Be Nice!  http://happyrehabdoc.blogspot.com/2011/12/tip-8-for-best-hospital-care-be-nice.html  

Tip #9: PAY ATTENTION!! http://happyrehabdoc.blogspot.com/2011/12/tip-9-pay-attention-more-insider-tips.html

Coming Up:

• SuperImmunity for Kids ~Part 2~!
• A Truly Healthy New Year
• Treating Pain with Food--more thoughts

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Her Husband Had Six Skull Fractures & The Surgeon Took The Time To Make Them Feel Like They Were His Only Patients That Day!! The Holiday Happiness Marathon Continues!!

The HOLIDAY HAPPINESS MARATHON Continues!!!!! 

Welcome All My Guest Bloggers--Doctors, Nurses & Patients whose stories warm our hearts....Here is Another Story From a Patient!

My good experience with a doctor was when my husband had surgery on his face 2 yrs ago. He had a maxillofacial doctor who was amazing!  There was something unique about him from the very beginning; even his entrance to the hospital room was slow and relaxed. He really did make us feel like we were his only patients that day.  He never seemed to be in a hurry and he answered all of our questions.  I remember him explaining every detail of the surgery - so much to the point that I didn't even have many questions when he was done.  


He explained what the face was like to begin with - comparing it to a puzzle, then explained what the problems were, how he planned to correct it, how the material would affect him, and details after he healed...  


When you have a loved one you are worried about in the hospital bed, you're sleep deprived, and stressed.... you don't respond well to fast descriptions of tomorrows surgery.  I don't think he spent a huge amount of time with us..  It actually saved time because his first detailed run down saved all those questions and him having to repeat himself.  I think some patients/families will unknowingly ask repetitive questions simply because they just don't get it the first time around- and they are trying to figure it out.. 


Before the surgery the doctor seemed confident and patient.  He was reassuring and positive.  I remember not even feeling nervous in the waiting room.  Once we were home and went to his office for the follow up - again he was gave us everything we needed to know about the healing process.  I have to say he really made us all feel at ease.  


And of course, I can't leave out this part -his work was amazing - you would never know he had 6 skull fractures by looking at him.


Allison in Columbia, S.C.

Thank you Allison for sharing your story with us!! We love doctors who take the time to explain things to us!  Does anyone else have a similar experience with a kind doc?:-))

Previous HOLIDAY HAPPINESS MARATHON Posts:

• A Pediatric Anesthesiologist Loves Being a Doctor & Is Grateful for Patients' Parent's Trust!!
• After Having Brain Tumor Surgery, A Patient is Grateful for "The Best Nurse I've Ever Had!"
• She lost 60lbs, Got Her Health Back and Is Grateful for Her Doctor for Saving Her & Her Husband's Life by Recommending a Plant-Based Diet!!
• A Psychiatrist is Grateful She Helped a Patient Get His Life Back After Alcoholism & Liver Disease

After Having Brain Tumor Surgery, A Patient is Grateful for "The Best Nurse I've Ever Had!": The HOLIDAY HAPPINESS MARATHON continues!

The HOLIDAY HAPPINESS MARATHON Begins!!!!! 

Welcome All My Guest Bloggers--Doctors, Nurses & Patients whose stories warm our hearts....Here is Our FIRST Patient Story!

After having brain tumor surgery, I was in the ICU at the hospital for 2 weeks.  There, I had a nurse named Liz.  Her family was originally from the Bahamas, so she had the remnants of an islander accent.  I was never as happy as when I heard that voice on the other side of the curtain.

She was the best nurse I’ve ever had! And it wasn’t because she was the sweetest, kindest nurse I have had.  In fact, she was mostly matter of fact, firm, and business-like.  But …. She listened.  She didn’t ignore me when the pain in my head was overwhelming, and I rocked back and forth on my hospital bed in pain.  She matter-of-factly told me that I needed to calm down and stop crying because it would only make my head hurt worse, if I did that.  But… she got me the pain medication that I needed.  Notice I didn’t say that I wanted…. It was what I needed.

She had to tell me the hard things and show me the not so pleasant things.  But….She listened.  She answered my questions, even though they were most likely quite obvious to her.  She didn’t get annoyed when I asked her the same questions for the fifteenth time.

She was the one who listened to my husband as he expressed his frustration over my overly emotional behavior after surgery, and she was the only one who explained that this was normal after brain surgery, and it would go away.

Liz was the consummate nurse:  a professional who did her job well, and made sure that I was doing what I needed to get better.  At the same time, she was personable:  Listening to her patient, showing care and concern, being willing to carry on a conversation instead of just walking in and out of my room.

To all the nurses out there who are like Liz – I thank you and your work does not go unnoticed!

~Joanna Shumaker in Tennessee

Thank you Joanna for sharing your story with us!!  Readers--have you ever had a wonderful experience with a nurse?  Share with us in the comments! :-))

Previous HOLIDAY HAPPINESS MARATHON Posts:

• A Pediatric Anesthesiologist Loves Being a Doctor & Is Grateful for Patients' Parent's Trust!!

Tip #9: PAY ATTENTION!! ~More Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Ok so today we are continuing our series on how to get the best medical care while you are in the hospital. This post does put bodily functions front and center but I can't tell you enough how important it is to be aware of the following items.  You can save your own life ten times over just by making sure these aspects of your care are properly managed.


For my new readers, look to the bottom of this post for links to Tips #1-8!:-)


Tip #9:  Pay Attention


As much as I hate to admit it--hospitals are dangerous places.  There are so many sick patients and so many opportunities for error.  If you know what to look for however, you really can prevent nearly ALL of these problems.


Ok, now here are the KEY things to pay attention to (I developed this list in consultation with my husband, the Happy Nurse, since he is an ICU nurse & therefore an expert in skin, bowl, bladder, eating, meds & mental status.  So now you have both the nursing and the physician perspective).:-)  This post is written as if YOU are the patient, but you can also apply this information if you are a family member or friend of a person in the hospital.  If the patient is too sick to "pay attention" than you as a family member can advocate as I suggest below & pay attention on their behalf.


Hand Washing:  You need to ask EVERY single person who walks in your room (staff, friends, family) to wash their hands or sanitize them with the alcohol gel.  This in an uncomfortable thing to do but it also is the MOST important thing you can do to protect yourself in the hospital.  Just say "Excuse me, if you don't mind, I didn't see you wash your hands.  Can you please clean them with the gel before coming in further?  Thank you!"  


Meds:  KNOW your meds (remember my "How to Make A Medical Info Sheet post: Tip #4: Know Yourself) and also know what meds you will be taking in the hospital--your inpatient medications may be very different than your home meds.  ASK FOR AN INPATIENT LIST OF YOUR MEDICATIONS WHEN YOU ARE ADMITTED AND KEEP THAT LIST NEXT TO YOUR HOSPITAL BED AT ALL TIMES.  As your nurse gives you your meds, she/he is required to tell you what she is giving you.  Cross check the names of EVERY med that the nurse gives you with your list.  If there is a new med, ask her/him to explain why it was added.  Sometimes you will find that the nurse may accidently have nearly given you the wrong meds.  Make sure the nurse manager knows but be compassionate to the nurse--unfortunately this happens all the time and sometimes its the pharmacy's fault!  Try NOT to refuse meds without letting the doctor know first.  Ask questions and advocate for yourself (like I suggested in Tip #1: Be A Teammate!) but remember--we have been in school/training for a minimum of 12-18 years + our years in independent practice.  Sometimes its good to trust that judgement (not always, but most of the time its a good idea). 


Skin: This is VERY important. EVERY day, your family member & nursing should:
-check ALL points of contact of your body with the bed & check skin from head to toe for dryness, rash, cuts, bruises, etc.  Many of these skin issues are normal (particularly bruising & dryness) but they should be documented.
-The Happy Nurse recommends checking specifically for ULCERS/SKIN BREAKDOWN in the following areas:  the back of the head, elbows, shoulder blades, buttocks & heels.  At the buttocks, check between the folds because many ulcers start at the sacrum.  Also, staff should daily check the genital region for any skin issues.  An ulcer is NEVER a normal finding and should be treated immediately that day.
-Send modesty out the window my friends, skin issues take FOREVER to heal and are very susceptible to infection.  Let them look!

Urine: Watch for dramatic decreases or increases in output, change in color from yellow shades to reds or browns.  Bring all of these to nursing & the physician's attention.  Dramatic increases may mean a Urinary Tract Infection is brewing or it could just be because you've gotten IV fluids!  Dramatic decreases are VERY serious--make sure they check your kidneys.  If you have a foley catheter in make sure you consistently ask your doctor if it can be removed.  The longer it stays in, the higher the risk of infection.  Sometimes it is necessary to keep the catheter in, but other times, doctors forget to discontinue them so ASK!


Stool:  Watch for absence of bowel movement, increase in bowel movement (particularly if very liquid), change in color to black, tarry or bloody.  If you are taking pain medicine of any kind, I put my patients on a bowel regimen of stool softeners & laxatives daily.  Ask your doctor if that is a good idea (there are contraindications).  If you haven't had a BM and are not passing gas and are having severe abdominal pain, this can be a medical emergency.  Tell your nurse immediately. If absent BM but still passing gas for more than 3 days--ask for aggressive bowel management (from both directions--oral meds & rectal meds) if its safe for you & insist on an enema if nothing by day 4.  If liquid, very frequent and FOUL smelling--ask to be tested for C. Difficile or other infection.  


Eating:  If you have "no appetite," force yourself to eat unless you want to stay in the hospital!!  This is particularly important for older patients!  If you just can't manage any food, ask for Ensure or Glucerna or another oral supplement.  If you simply don't like the food, get permission from your doctor to have your family bring you HEALTHY food with lots of green vegetables & also foods with iron in them if you are anemic.  Dark leafy greens are particularly good but make sure your doctor knows you are eating them if you are on Coumadin (warfarin) so they can adjust your Coumadin dose appropriately.  Never eat food from home without your doctor's explicit permission.  DRINK a lot of water & other fluids, unless you are on a "fluid restriction."  Ask your nurse before drinking a lot--if its ok, then drink b/c you will help with constipation and prevent dehydration.  Do NOT drink sodas!!!!!


Mental Status:  Sometimes in the hospital you may get confused at night and may act in bizarre ways.  You may not remember this in the morning.  Make sure to ask your nurse about this because delirium can actually be deadly.  It may be due to medications or infections.  If you are confused at all during the day or night--bring this up to your doctor on rounds (remember how rounds work, check my post: Tip #2: Be Concise & Organized).  Family members with older patients, make SURE to ask nursing about this and bring it up to the doctor--common causes of delirium include: infection (particularly urinary tract infections), disorientation due to lack of glasses/hearing aids, loss of day/night cycle (make sure that the hospital room is dark & quiet at night and bright during the day to orient you properly), medication side effects and cardiac issues.  Unless it is absolutely necessary according to the doc, ask the doc to stop or reduce the dose of any meds if they are producing this effect.

***CAVEAT--if you find any problems with your care, please point it out politely.  Please also bundle your requests into ONE conversation, like I discussed in this post: Tip #8: Be Nice.   You will DRIVE STAFF CRAZY and really make them massively annoyed if every time they come in the room they are being peppered with requests. This annoyance level WILL effect your care.  Mention it ONCE at the beginning of the nursing shift (Remember what I told you about the the nursing shift schedule Tip #5: The Hospital Routine).  I recommend you ask the nurse as follows:

"I'd like to make sure that I get my skin checked thoroughly today & I know you are super busy but when you have a moment today, could we also talk about how my bowel, bladder, eating & mental status is doing?"  

Pick a time during the day to remind the nurses to check all these things before the end of his/her shift if they haven't gotten back to you from your inital request.  Good reminder times:  1pm for day shift.  10pm for night shift. ***

OK!  I think that wraps it up for this medical system post!  Hope this was helpful to you!  Next time we finish this post series with Tip #10:  Try Not to Be Alone!


Here are the links to my previous posts on these subjects:

Tip #1: Be a Teammate & Tip #2: Be concise & organized: http://happyrehabdoc.blogspot.com/2011/11/how-to-get-best-medical-care-insider.html
Tip #3:  Key Questions to Ask Your Doctor: http://happyrehabdoc.blogspot.com/2011/11/tip-3-key-question-to-ask-doctor-in.html
Tip #4:  Know Yourself--How to Make a Medical Info Sheet:  http://happyrehabdoc.blogspot.com/2011/11/tip-4-key-things-you-need-to-know-about.html
Tip #5: Know the Hospital Routine: http://happyrehabdoc.blogspot.com/2011/11/tip-5-what-is-hospital-routine-part-4a.html
Tip #6:  Know the Role Everyone Plays in the Health Care Team: http://happyrehabdoc.blogspot.com/2011/11/tip-6-know-role-that-each-person-plays.html
Tip #7:  Know Your Doctors: http://happyrehabdoc.blogspot.com/2011/11/tip-7-know-your-doctors-short-guide-to.html
Tip #8:  Be Nice!  http://happyrehabdoc.blogspot.com/2011/12/tip-8-for-best-hospital-care-be-nice.html

Coming Up This Week:

• BOOK REVIEW:  "29 Gifts!"
• SuperImmunity for Kids ~Part 2~!
• Practical Stuff:  Kitchen Tools That Help & Products I Like! (Gift Ideas?!)

Coming Up Next Time on Medical System Tuesday: 

• Tip #10 For The Best Hospital Care:  Try Not to Be Alone! ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Tip #8 For The Best Hospital Care: Be Nice ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Today we continue our series on how to get the best hospital care--this post is pretty much common sense but you would be surprised at how easy it is to have The Golden Rule disappear out the window in crisis.  The purpose of this series however is for you to learn how to get the BEST hospital care, and if I didn't mention this than I would be remiss in achieving this goal.  


Please be nice is the FIRST & strongest piece of advice I gave my hospitalized family member AND all other members of my family.  So they were nice and things went a lot better (nurses gave quick assistance with a smile & physicians spent longer time in the room).  Take this advice to heart--if you do nothing else, follow this tip!


Tip #8:  Be Nice:  One of my Mom's best friends always said: "You catch more flies with honey than with vinegar."  This REALLY applies in the hospital setting.  I realize that when your are sick you don't feel much like "making nice" and when you are worried about your family you "just want answers." But the reality of the situation is that medical personnel are just that--people! 

Every person wants to be treated with courtesy and you WILL get better & more responsive care if you are kind to the nurses/physicians/techs/cleaning persons/administrative assistants/social workers/dietary staff.  

I know (from being on the patient side of things) that some staff members don't return the favor & this may not seem fair.  To be honest, I had to sometimes ACTIVELY tell myself not to snap at people last week as I sat with my sick family member.  I kept reminding myself of the following key point:  most staff members are not actively trying to be rude--they are stressed, they are understaffed & they are trying to please a lot of different people at once.  By surprising them by being nice, they will look forward to coming into your room--this translates into more attentive care.

With regards to the nursing staff & techs--one last thought.  Please remember not to treat them like they are your servant & remember that you are not their only patient.  Don't "speak down to them."  If you need something within your own reach & you are well enough than get it (*without doing anything you were told NOT to do by the nurse/doc*), than do it for yourself. 

• Please don't be like a patient I saw the other night who had the staff running in and out of the room trying to please her requests.  The evening culminated in her asking me to comb her hair & get her skin cream for her even though both items were on the tray in front of her & she was more than capable to do so herself.  I had to sit down & talk to her about the importance of bundling her requests & asking only for things that she cannot do herself so the staff could do their job for all the other patients on the floor.  After the explanation she seemed to understand & the staff enjoyed caring for her much more!  

That said, there are limits to this suggestion. If you believe that someone is actually actively being harmful to your or your family members than ABSOLUTELY you should stop them firmly & ask to talk to the nurse manager or patient care advocate immediately.  If its an issue with a doctor you can "ask for a second opinion."  Just no matter how angry you are, take a deep breath & ask nicely--things will get fixed a lot faster.

Coming Up Next Time on Medical System Tuesday: 

• Tip #9 For The Best Hospital Care:  Pay Attention ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Coming Up This Week:

• BOOK REVIEW:  "29 Gifts!"
• SuperImmunity for Kids ~Part 2~!
• Practical Stuff:  Kitchen Tools That Help & Products I Like!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

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!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.

Tip #6: Know the Role That Each Person Plays In The Hospital Team (quick cheat sheet) ~ Insider Tips on How to Get the BEST Medical Care in the Hospital ~

Who are all those people working in the hospital & what do they do?? 

Continuing our journey into the foreign land of the hospital, lets meet the team...

• Nurse:  Your tour guide.  Responsible for your day to day care. Manages meds, personal care, intake & output & executes doctors orders.  Eases patient's anxiety and deals with overwhelmed (and often emotional, highly stressed) families. Have the most comprehensive view of the patient's condition & can usually make or break a patient's progress.  Their insights are extremely valuable.  Most are very intelligent, highly educated or experienced and have the patient's best interests at heart. Some are not and do not (but I've found these folks to be few & far between).  There are a lot of different kinds of nurses:  RN, LPN (LVN), APN(NP)) and I'll devote a guest post to my husband (THE HAPPY NURSE) to explain all of these sub-types and specialties but on the floor you will usually see either RN's or LPNs/LVNs. A good medical team always takes nurses' assessments into account with great weight when making any patient care decisions.  I do not recommend being rude to your nurse.  Please treat them with the respect they deserve.  Frequently understaffed.

• Tech:  Your helping hand.  Responsible for a long laundry list of tasks including: recording vitals, running EKG's, assisting nurses in complex tasks (i.e. wound care, etc), helping you to the restroom, helping with your grooming/bathing/dressing & managing your transfers (moving from the chair to the bed, etc) so you won't fall.  Also many times get stuck running patient's errands.  Be very nice to them.  They are not your servants. Also frequently understaffed.

• Social Worker:  Your tour management company.  Responsible for coordinating your admission and discharge.  Arranges home services, equipment, transportation and plugs you into community, government resources.  Tracks down absent family members to assist with your care upon discharge & obtain data on your advanced directives, insurance, etc if you are unable to do so.  Manages the majority of communications with your family as a whole.  Directs "family meetings" about end-of-life issues & your care plan.  Overworked, underpaid and usually extremely nice people.

• Physical Therapist (PT):  Your Coach.  The key to your physical independence.  Their job is to help you walk again, get you strong, and push you to become as independent as possible. They are experts in the appropriate exercises for each specific surgery, illness or injury.  They generally tailor your program to return to or exceed your pre-hospital activity level upon discharge or after home/outpatient care.  They focus primarily on training the lower body and OT usually focusses on the upper body, but there is overlap. These people are extremely nice and motivated.  I have yet to meet a PT (or OT for that matter) that I don't like.

• Occupational Therapist (OT): Your ADL guru.  In rehab, the term "ADLs" refers to "Activities of Daily Living" and OT's are the experts in these.  Eating, bathing, dressing and toileting are the basics, but their skills range to helping physically replicate your daily routine (i.e. cooking, laundry, etc) to allow you to function as independently as possible at home.  They are extremely innovative in providing you with adaptive devices that can allow you to function independently--from splints to "reachers."  Once again, nicest people ever!

• Speech-Language Pathologists: Your Translator. Most of you will not meet these therapists but if you have trouble swallowing, speaking or processing language (like after a stroke), these people will be your best friend.  They are exceptionally well-trained and patient.  They do things ranging from the extremely technical (modified barium swallows and FEES to determine the quality of your ability to swallow) to the physical (speech & swallow exercises).  They also do cognitive assessments in patients with suspected dementia or brain injury.  Once again, like all the other therapists--I have found them to be VERY kind.

• Nurse Pracitioners & Physician's Assistants:  Your Doctor's Point Person.  Depending on what state you are in, responsibilities & level of independence of NP's and PA's varies.  Detailing the differences between each & their training is going to have to be a future independent post as it is very complicated to describe each one's scope of practice.  For your purpose's know that they are the DIRECT line to your doctor.  They often have more experience than the doctor they work with and can offer you very important information.  They will manage your day to day care in the hospital if the doc doesn't have any residents (and sometimes even when the doc does!). If they are a surgeon's PA or NP they are often in the OR with the Doc assisting in the surgery as well.

• Doctors: Your Team Leader:  I'm going to devote a whole post this week to doctors.  For now know that the different categories of doctors include:
• Attendings
• Fellows
• Residents
• Interns
• Medical Students

• Dietician:  Your secret weapon. Obviously I'm a huge fan of anyone whose job revolves around helping my patients become nutritionally healthy.  The dietician does nutritional assessments, makes recommendations to the team on how to nutritionally optimize your ability to heal and can intercede on your behalf to improve your meal choices & content.  Once again, very nice, very smart people.

Other people you will see who are not involved in DIRECT clinical patient care include:

• Administrative Assistant for the Unit (also known as the Unit Secretary depending on the hospital):  This person has a crazy intense job.  They answer phones & patient call lights & communicate needs to nursing staff.  They organize all the massive paperwork in everyone's charts.  In hospitals without electronic medical records, they enter all the orders.  They administratively admit & discharge patients--serving as a hub for coordinating all the services on the floor--from housekeeping to transport to maintenance.  I'm sure I've missed a bunch of stuff but you get the gist.    
• Housekeepers:  Big job, small time frame.  These folks have to clean and sanitize rooms between patients (very time-pressured turn around) AND make sure patient rooms are kept hygienic.  They deal with contaminated trash & are responsible for managing all that laundry you see everywhere! A key role in minimizing hospital infectious diseases. Without them, all those MRSA and VRE patient rooms would spread disease from one patient to another. A lot of work, very underappreciated.
• Dietary Staff:  manage your food--from ordering to delivering.  You see these folks three times a day and often their sunny moods (or lack thereof) really sets the tone for the day.  They have to keep food hot through long distances and make sure that each patient gets the right food (key--we don't want the kosher patient eating pork, etc!).  A busy job!

{NOTE:  I know the above descriptions do not NEARLY capture the full extent of the responsibilities in each position!  I just tried to hit the highlights!!}

Next Time on Medical System Tuesdays (new feature on the blog):

• Tip #7:  Know Your Doctors: A Short Guide to Hierarchy! ~ More 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!!

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.  Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. The Happy Rehab Doc expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered as a result of your reliance on the information contained in this site.  By visiting this site you agree to the foregoing terms and conditions.