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.

Tip #5: What is the Hospital Routine? (Insider Tips on How to Get the BEST Medical Care in the Hospital)

Being in the hospital is literally like moving to a foreign country.  People eat & sleep at different times. There are all these people wandering around but you don't who they are or what they do.  A lot of the time it feels like everyone is speaking a foreign language.


Tips #5 & #6 are your travel guide:  


Tip #5:  Know the hospital routine:

• Nurses & Techs usually change shift at 7 am & 7 pm.  If you want ANYTHING (especially pain medication) ask for it BEFORE 6pm or 6am.  Do not expect to have any response to requests between 6:45pm-8pm or 6:45am-8am unless it is an emergency & you are seriously ill.  Family members & patients:  do not ask to talk to a nurse during this time frame.  Why? They are giving report to the next nurse or tech.  If you want the next nurse to have ALL the important details about your family member or yourself than you should allow them to transfer care uninterrupted.  Your care on the next shift will be better!

• Social Workers:  they usually work 8am to 4/5pm & are INCREDIBLY busy & overworked.  Most ones I know end up staying after the time they are supposed to leave.  If you want to meet with them, don't ask to do so after 3pm.  Ask early & it will happen.  Ask late & you may have to wait until the next day.

• Physical & Occupational Therapists:  they usually work 7am-4pm.  They usually see their last patient at 3pm.  You will not be able to talk to them after this time & You probably won't ever have therapy after 3pm.  

• Dietary Staff & the Kitchen:  They bring trays to patients at Breakfast (usually 6am-8am); Lunch (usually 11am-1pm) & Dinner (usually 5pm-6:30pm).  If you want snacks in between meals you will need to talk to the Dietician or the Nurse.  On the floor they usually have a few sodas, crackers, applesauce/pudding & juices.  Don't expect a big spread in between meals.

• Doctors:  We usually sign-out our patients around 5pm to the person covering for the night.  This does not mean we leave then--I regularly work past 6pm--but what it does mean is that if you ask for your doctor after 5pm you usually won't get them (you will get the night person).  Ask before 4pm if it is urgent that you see them that afternoon.  But as noted above, if you have further questions that aren't answered in the a.m. rounds & are very important to be answered that day, ask the doctor in the morning if they have time to come back in the afternoon before they leave

Next time:  Tip #6:  Know the Role That Each Person Plays In The Hospital Team ((Who ARE These Different People Taking Care of You & What DO They Do??!!))

Coming Up AFTER Thanksgiving:

• 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.

PAIN: How to Treat Everything From Arthritis to Back Strain With Food (Part 1)

About a year ago I was in a car accident and herniated a disc in my neck.  It caused me excruciating constant daily pain.  After 6 months of daily high dose anti-inflammatory medications (I was on Mobic), 2 cycles of physical therapy, 30 acupuncture sessions and a ridiculous amount of money spent on massages, my doctor (another Physical Medicine & Rehabilitation Doc) told me rather sadly that he thought I had now completely exhausted conservative measures and it was time for me to think of "facet injections" (steroid injections) to my cervical spine.  This terrified me.


I had been in the OR during many of these procedures with highly skilled attending (senior) physicians specially trained in interventional pain.  These procedures were relatively routine in my world, but every time I thought about getting the injections I thought about the (rare) complication of injury to the spinal cord.  Working in rehab, I've worked with spinal cord injury patients, and I really didn't want to become one myself.  While their stories are often inspiring, no one would willingly choose to sit in their shoes for even one day.  I started doing some research to try to find another way.


Late one night I found a website of a woman sharing her story of how she healed her neck pain with a combination of physical therapy, stretching regimens, acupuncture, massage and "eating an anti-inflammatory diet."  What the heck did that mean?  An "anti-inflammatory" diet??  I had already lost 70lbs, wasn't that enough alteration in my eating habits?


So I started reading, and then I started doing, and now--I am a passionate believer in the power of dietary change to reduce and eliminate inflammation. And by eliminating inflammation I've eliminated pain. 


Two months after starting an anti-inflammatory diet in conjunction with a third round of PT, I was able to get off the Mobic (my daily NSAID medication).  One month later, I no longer had constant pain throughout the day.  


Now, 6 months after starting to reduce the inflammatory foods and increase the anti-inflammatory foods I consume I can honestly say that I can have several days go by without pain--with an even more noticeable improvement in the last 2 1/2 months since becoming Vegan.  Yes, I do sometimes feel the pain--but it hurts when it makes sense to hurt--I'm doing a repetitive action with my neck or back, using muscles that I hadn't strengthened sufficiently.  So duh--I was hurting!

I've been so impressed with this amazing (miraculous to me) transformation in how my body FEELS that I've done even more research and really want to share what I've learned!  In my next post I'll talk about the medical science that backs it up and how to more specifically treat diseases of inflammation, particularly Arthritis, Muscle Strains, Fibromyalgia, and more!  Over this week I'll also post a third post talking about other diseases of inflammation that I do not treat in my specialty--diabetes, heart disease, cancer.

I want to particularly recommend two amazing books with highly relevant information:

1) The Anti-Inflammation Diet by Dr. Jessica Black, N.D.  AMAZING Book--soooo worth the $12 price on Amazon--particularly the table on p.42-43

2) SuperImmunity for Kids! by Dr. Leo Galland (yes its about kids at every lifestage, but if you read through it you can find a whole heck of a lot of good data for adults too!!)  Dr. Galland is what got me interested in nutritional healing of all kinds--I've been reading this book cover to cover for about 10-15 years!!

In closing though, I won't leave you without a carrot for next time (no pun intended):-). 


Here is a GENERAL table of known inflammatory and anti-inflammatory foods.  In Part 2 I'll talk more specifically about which of these foods is most important for Arthritis vs Acute Muscle Strain vs Fibromyalgia, etc.  


The degree of inflammation in each individual can be variable--Jessica Black's book does an excellent job of mapping out a plan for how to do a complete elimination diet (she has more foods listed & substitutions for each one) in her book.  If you are interested in embarking on this path, get her book and read it because she is FAR more knowledgeable than me on this!!  


That said, here is a list of Anti-Inflammatory and Inflammatory Foods synthesized from lists by four leaders in this field:  Dr. Jessica Black, N.D.; Dr. Andrew Weil; Dr. Leo Galland and Dr. Neal Barnard.  **Please see the notes below the table--one of my readers shared with me some more information on other potential inflammatory foods!!**

Inflammatory Foods 1.         Sugar (particularly white refined sugar & high fructose corn syrup)*  2.         Dairy Products* 3.         Meat (beef, pork, chicken,            turkey, fish—except wild      Salmon)* 4.         Corn* 5.         Wheat (gluten)*—more on           this later 6.         Caffeine* 7.         Sodas—even Diet sodas*         (Diet sodas manipulate the fat in your body to actually make it harder to lose it!  More on this in a later post) 8.         Tomatoes & Peppers 9.         White Potatoes 10.      Citrus fruits 11.       Alcohol 12.      Peanuts  13.  Peanut butter 14.  Tofu and Soy {* items are for most of the population—items 8-14 inflammatory foods are individually problematic)

Anti-Inflammatory Foods       1.     Omega-3 Fatty Acids (ground flaxseed meal)       2.     Pineapple (more on this later)       3.     Blueberries (see note below), raspberries, cherries, prunes       4.     Papaya       5.     Kale, Spinach, Collards & other dark leafy greens       6.     Broccoli & Cauliflower       7.     Other Fruits & Vegetables—except tomatoes, potatoes, eggplant, peppers       8.     Garlic       9.     Ginger      10. Turmeric      11. Most nuts & seeds (not peanuts)      12. Teas (particularly Roobios, Macha, decaffeinated green tea)      13. Shiitake, Oyster & other Asian Mushrooms      14.  Sweet Potatoes      15.  Quinoa, buckwheat (not a wheat product), wild rice, barley, steel-cut oats      16.  Wild Salmon

Additional Notes: One of my readers shared the following information with me from  Dr. Norman Childers: Arthritis Nightshade Research Foundation,  She got outstanding relief from her pain by removing all foods and products that contain "solanine.":  "blueberries, apples, artichoke, okra, sugar beets and all products that contain paprika/chili spice and potato starch (PS is commonly found in bakery products, thickeners for soups/sauces, excipient fillers in vitamins/supplements/medications)."  I have not had an opportunity to investigate this material myself, but she has been kind enough to provide some citations from the ANRF website (above) and Michael Fowler's e-book "Nighshade Free, Pain Free" which she recommends.  Thank you Jen Siskind!!  I'll look forward to checking the citations out myself in the coming future! :-)


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.


NEXT:  COOKING IN BULK TIPS #1!  This week with recipes from The Happy Herbivore

Coming Soon:

• How To Get The BEST Medical Care: Tips to Patients from a Doc
• RECIPES & Ideas:  Snacks!  YUMMY & Portable Plant-based Snack Food--all Sugar-free, Gluten-Free, & Without Added Oils or Fat!!