Hospital Personnel

Who Are All Those People in your Hospital Room?

Hospitalization, particularly at a full or part-time teaching facility, can be a bewildering experience with a seemingly endless array of strangers in and out of the patient’s room, often appearing to repeat one another in redundant activities, exhibiting lack of organization, and uncertainty about “who is boss.”

Who Entered the Room?

Physician Hierarchy

• Attending Physician: Has overall responsibility. Must coordinate all care. Should make ultimate decisions and be directly responsible to the patient
• Consulting physicians:
• Specialists and Sub-specialists called upon by the attending physician to help. May include: 1. Surgeon for specialized secondary procedures 2. Radiologists 3. Pathologists 4. Infectious disease 5. Pulmonology 6. Many other specialties
• Fellow: MD at or near end of residency or just completed or recently completed new Post Fellowship Doctor
• Chief Resident - In teaching hospitals
• Third Year Resident
• Resident – 2nd year student
• Intern
• Medical Student

Nursing Hierarchy

• Nurse Supervision or Nurse Manager
• APRN – Advanced Practice Nurse (in most states similar to Physician’s Assistant)
• Charge Nurse
• Staff or bedside nurse
• Licensed practical or vocational nurse—limited licensure
• Nurse assistants, patient care assistants

Other Hospital Staff Terms

Attending Physician

• Senior physician directly responsible for care
• Boss of the “house staff”

Hospitalists

• MDs who specialize strictly in caring for hospitalized patients; generally employed by the hospital.

House Staff

• All doctors-in-training
• Interns, residents, and fellows
• Found in teaching hospitals

Fellows

• Below attending physicians, assisting and generally completing residency or just completed.

Residents

• Post-medical school, OJT training physicians performing three-to-seven year residencies depending on specialty.

How do these people get involved?

It is undeniable important to read, appreciate, and understand your admission form. It may be possible to negotiate the form’s terms, if they are unacceptable. The form probably contains a consent that you be cared for by students, interns, etc. at a teaching hospital. In addition, the form may contain significant consents, waivers of rights, limitations of remedies, etc.

Contributing to Accurate Diagnoses and Proper Plans and Care

Plan your consultations with your physicians—even in your hospital room, such as:

• Make notes in advance.
• Be specific.
• Avoid long complications, but provide meaningful detail.
• Do not rely on your ability to relate symptoms that occurred three hours ago from memory.
• Prepare questions and ask them.
• If you are in doubt about whether sufficient information is being taken down about you, give a copy of your notes to the doctor, nurse, or both, and specifically instruct that they be included in your medical records. This is proper if, but only if, the notes are prepared so they will hold diagnostic significance.

Preventing Medical Errors

Planning your communications, using notes made in advance, and recording major statements made immediately after consultations with follow-up notes for your own records, will help reduce communication errors.

Practices should include:

• Try to avoid telephone communications that could result in a physician giving orders over the telephone.
• Check your own medical record. You are entitled to see your medical chart while in the hospital. Look at it.
• Verify that physicians have consulted with one another and not simply looked at notes in your chart.
• Report all unusual conditions about yourself with which you are familiar. This includes, for example, infections, respiratory congestion, and allergies of all kinds, whether inquired about or not.
• Make certain the allergies you report to physicians are recorded, i.e., written down.
• Use an advocate.
• Make certain the advocate is a reasonable person.

Advocates: Beware of Warning Signs

These are telltale signs that a patient’s condition is changing, and the changes must not be disregarded. Don't tolerate being ignored when these problems are present, demand attention.

Warning signs of a rapidly declining patient include:

• High or low Body Temperature
• Changes in heart rate (pulse) or respiratory rate (breathing)
• Changes in blood pressure, especially rapid drops
• Mental confusion
• Decreased, or unusual colored urine
• Patient complaints
• Shortness of breath
• Acute pain, especially in the abdomen
• Pale appearance, or cold sweats
• Patchy skin or other unusual appearance condition