Who Are All Those People?
One of the universal comments I hear from patients and caregivers who have spent a lot of time at hospitals is the frustration with the endless parade of people who come to their room.
There are, of course, nurses and doctors, but with three nursing shifts a day at most hospitals, just keeping track of the nurses is a lot to ask. But then at a teaching/academic hospital, there can also be residents, interns, and attending physicians. There can be specialists like urologists as well as medical oncologists. There are hospitalists and palliative care doctors.
It's hard to keep track of all the specialists
This doesn’t even touch on the wide range of other specialized healthcare providers a patient might see. There are respiratory technicians, specialized doctors for particular systems such as pulmonologists or vascular specialists. There are occupational therapists and physical therapists. There are wound specialists.
Obviously, who will treat you depends on your given problem and the other systems it may affect. When you are in the trenches of a hospital stay, it can feel like there’s an endless parade of people who don’t always explain their role. It can be exhausting.
Different hospitals create different systems to help
I remember one emergency room visit in which every professional wore different colored scrubs. Doctors in blue, nurses in green, certain techs in brown. It was a good idea but they didn’t give patients and families clear information on what the colors meant.
At another hospital that my husband stayed, each person handed us a business card with his or her photo and title. This was excellent for knowing who they were and knowing their name for later reference. But the hospital also had to provide a binder with a folio for all the cards. A 10-day stay with three shifts a day can add up to a lot of people very quickly.
It seems there must be an easier way
I understand why so many different professionals must visit a patient. But I have for a long time wondered if there’s a more efficient, less-exhausting-for-the-patient-and-family way to do it. And despite thinking about this for years, I have no answers.
I don’t have the space here to go through every definition, but I thought it might be helpful to at least sort out the hierarchy of titles you might encounter among doctors in an American teaching hospital. The emergency room, in particular, seems to be the place (when you are most likely to already be overwhelmed) that you might be overwhelmed by different titles.
Some definitions might help
An attending physician
An “attending physician,” per the National Cancer Institute “Dictionary of Cancer Terms” is a “medical doctor who is responsible for the overall care of a patient in a hospital or clinic setting. An attending physician may also supervise and teach medical students, interns, and residents involved in the patient’s care.”
Albany Medical College also has a nice list of key definitions of these medical titles. It adds to the “attending physician” definition to say an attending physician has completed all training and is Board certified in their specialty. In other words, this is the doctor in charge. You might hear a resident in the ER tell you that the “attending” will be in soon to see you.
Per the Albany guide, a “fellow” is a doctor who has completed medical school and residency and is in advanced sub-specialty training. A fellow may also serve as an attending. Just to confuse you.
A “resident” is a doctor who has completed medical school and is gaining further training in a specialized field. Residents practice under the supervision of the attending physician. An “intern” is a resident in his or her first year of residency following medical school.
And one other type of doctor, whose title I’ve long found confusing, is the “hospitalist.” The NCI dictionary defines a hospitalist as “a medical doctor who manages and coordinates the daily medical care of patients while they are in the hospital. A hospitalist may also supervise and teach medical students, interns, and residents. A patient’s personal doctor will work with a hospitalist to care for his or her patient while the patient is in the hospital.”
It's not easy keeping it all straight but I hope this basic overview might help a little.
How well does your healthcare provider understand your bladder cancer?