WHO ARE THESE PEOPLE AND WHY ARE THEY ALL IN MY ROOM?–TEACHING HOSPITAL HIERARCHY

The following is courtesy of one of my fellow Colon Club members (reprinted with her permission), a nurse married to a doctor. It was written as advice to the wife of a colon cancer patient whose unsatisfactory experience at the small hospital to which he was originally admitted on an emergency basis led to his requested  transfer to a large teaching hospital. This nuts-and-bolts explanation  clarifies some of the crucial aspects of  how “The System” works that we, as patients and caregivers, could never figure out on our own. Because there is no “Hospital Hierarchy For Dummies” manual,  our lack of understanding is the source of many unnecessary headaches and heartaches for untold numbers of patients and their families.

If your loved one gets transferred to a teaching hospital, the doctors will likely want to redo much or all of the testing he/she has already had. This will NOT be a reflection of their incompetence, it’s just the way things are done. Because it is a teaching hospital there will be many, many more people seeing the patient.

Here’s a list of who you might see in your hospital room:

Medical students : post college and in training to be doctors, but not yet doctors

Residents : PG1,PG2, PG3, PG4 (i.e. post graduate years 1-4). The residents ARE doctors who are in the process of completely their training.

Fellows: probably years 1, 2 and 3. These are doctors who are completing SUB-specialist training — for example, a general surgeon training to be a colorectal surgeon.

The attendings: the head honchos.

When rounds are being done on the patient, there may very well be 10 docs or “docs-in-training” in his room. This IS NOT the time for you to really ask questions. Your questions should be one-on-one, and preferably to the Fellow or the Attending. You may get a lot of conflicting information from doctors under that level. Please don’t let that make you mad. It just is the way it is. Rest assured that all the big decision-making will come from the top down; the attendings will tell their underlings what to do, and their underlings will do it –or they will have hell to pay from the attendings.

There will be an attending doctor “on-call” 24/7, but that person will generally not be the patient’s own doc. There will be plenty of docs around 24/7, but in many, many cases they will want to wait until other staff is around before making big decisions or changes in orders. This is NOT a reflection of their incompetence, lack of caring, or laziness. It’s just how the system works.

When the patient gets to the teaching hospital, their doctors will  create a “problem list” which might look something like this:

1) status post colon resection
2) post-operative pain, poorly managed
3) paralytic ileus
4) aspiration pneumonia
5) rule out fungal infection, rule out MRSA infection
6) compromised renal function?
7)  elevated WBCs (pneumonia?, abscess?)

Then they decide who they need to call in for consultation. Just some of the possibilities: oncologist, oncology surgeon, GI surgeon, liver surgeon, pulmonologist (pneumonia), hematologist (anticoagulation), infectious disease doc (fungus, MRSA, elevated WBCS, whatever), gastroenterologist, thoracic oncology surgeon, nephrologist (kidney function), pain management specialist, and ostomy nurse. They will each have their own entourage.

I think you are already quite overwhelmed with everything that has been happening, and quite understandably so. I would strongly suggest that you get a tape recorder and record what each of the specialists says to you. You can return to the tapes and listen to them, both to better understand the plan and prognosis. It could help you have more confidence in what is so sure to feel absolutely overwhelming to you. I’m not trying in any way to scare you, but the chaos you’ve been through (people-wise) will be nothing in comparison to what you will face. This doesn’t mean that your loved one isn’t getting better, more cutting edge care that what he had before at the other hospital– but it WILL feel like chaos.

Even if you don’t love the new doctors and nurses, try to have faith that they know what they’re doing. It is natural to want to fight for the patient, but right now, fighting for him doesn’t mean second-guessing and trying to micromanage. Of course you want to– it’s a natural reaction– but no matter how much you want to, you just cannot do it. Just stay by his side, encourage him to comply with the docs’ directions, whatever they are. If it’s a day when he’s allowed to have some water, find out HOW MUCH. If  it’s an ice chips day, find out HOW MANY.

B-R-E-A-T-H-E, sleep, eat, be well.

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About surfingon

I live in Hawaii. I surf in the winter and swim in the summer. I have been a hospice volunteer with a contemplative-care oriented hospice for 25 years have been part of their team that trains new volunteers for the last 9 years. I have walked the colon cancer path with my beloved husband these past 5 years. He died very peacefully in April 2009. I now seek to share what we learned, to shed light on the many dark corners of this often mystifying, heartbreaking and heart-opening journey.
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