Who's Who in Your Hospital Health Care

“I’m sorry I don’t remember your name, I’ve seen so many doctors…and why are you here, again?”

When I see patients in the hospital, I hear this a lot. That’s because people admitted to a hospital are faced with a daily invasion of doctors, nurses, physical therapists, dieticians, and others. Some are dressed in hospital scrubs, some in short white coats, some in long white coats, and some look too young to drive.

If you’ve ever been in the hospital, you may have wondered who’s who. So, here’s a quick rundown of the people you may encounter during a typical hospital stay:

• Medical student — Sometimes called “student doctors,” medical students have not yet earned their medical degree (M.D.); these trainees have generally completed an undergraduate college or university degree and are in the midst of a four-year program in medical school. All orders, recommendations, and other professional activities of medical students must be approved by their supervisors, who include interns, residents and attendings (see below).
• Intern — These trainees have completed medical school (they have their M.D.) and are in their first year of residency training as part of licensure requirements. Also called “first-year residents,” these physicians tend to work the longest hours. In the past, it was not unusual for them to work 100 hours or more per week and spend every third or fourth night in the hospital. In 2003, U.S. training programs implemented a reduction in work hours to a maximum number of 80 hours per week. The internship year is also called PGY-1, meaning post-graduate year 1. Under direct supervision by a number of senior physicians, interns are expected to know nearly everything about the patients assigned to them; they are the first persons called by nurses and generally write all orders for medications, tests, and consultations.
• Junior resident — Physician trainees in the second year of residency (or PGY-2); they supervise interns, teach medical students and interns, and are themselves learning and becoming more independent.
• Senior resident — A physician trainee in his or her third year of residency, also called a PGY-3. They supervise interns and medical students, have an increasingly important teaching role, and are preparing themselves for independent practice, which follows this year of training for many. In some fields, such as surgery, residency continues beyond three years; in the fourth year, the physician might simply be called a fourth-year surgical resident, or PGY-4.
• House officer — This generic term refers to interns and residents.
• Fellow — For physicians who have completed the three or more years of residency and choose to pursue subspecialty training, fellowship is the next step. If you are hospitalized with a heart problem, the first cardiologist you see may actually be a “cardiology fellow.”
• Attending — These are physicians who have completed their training and practice medicine independently, without required supervision. This term applies to medical doctors (M.D.s) who practice internal medicine, surgery, psychiatry or any other field of medicine. Because they have completed a residency program, they are “board eligible” and if they have passed the qualifying examination, they are “board certified.”
  
  The term “attending” is usually used in the hospital, referring to the physician of record, the one person who is ultimately responsible for a particular patient’s care. But the term also applies to others who have completed their training. Examples of attending physicians include:

• Internist — Not to be confused with “intern,” an internist is a physician who has completed a residency in internal medicine and provides medical care to adults. Often called “general doctors,” they may or may not have completed additional specialty training.
• Specialist — These attending physicians have already completed a residency and have had additional training in a specialty fellowship program. They may have passed a specialty certification examination (making them “board certified” in that specialty). Examples of attendings who are medical specialists include:
• • Allergist (allergic disease)
  • Cardiologist (heart disease)
  • Endocrinologist (hormonal disorders)
  • Gastroenterologist (digestive disease)
  • Hematologist (blood disease)
  • Infectious-disease specialist
  • Oncologist (cancer)
  • Otolaryngologist (ear, nose and throat disease)
  • Nephrologist (kidney disease)
  • Neurologist (nervous system disease)
  • Pulmonologist (lung disease)
  • Rheumatologist (joint disease)

Other fields have their own subspecialties. For example, graduates of a surgical residency may choose additional training in hand surgery or cosmetic surgery; obstetricians may choose high-risk pregnancy training; and dermatologists may choose to learn more about skin-cancer treatment well beyond what is covered in their residency training.

During a hospital stay you may meet a number of other health care professionals who are not physicians. These include physician assistants, nurses, nurse practitioners, nurse specialists, physical therapists, dieticians, transporters (who help move people around the hospital in wheelchairs or gurneys; previously called “orderlies”), phlebotomists (people who take samples of blood), and receptionists. Their roles should be clear, especially if they have introduced themselves. However, in some situations, it can be confusing, especially when their dress and behavior are similar to a physician's or medical trainee's.

For example, a nurse anesthetist may be hard to tell apart from the anesthesiologist. However, there is a clear supervisory role for the physicians working with non-physicians. And it’s the physicians who are ultimately responsible for the care delivered.

Ideally, anyone you meet during a hospital stay will introduce themselves the first time and remind you later who they are. In addition, they should be wearing nametags.  Write down the names of the people caring for you or ask a friend or family member to help you keep track of everyone.

Good communication goes a long way toward sorting out who’s who. If you don’t know who someone is, just ask. No one involved in health care should be offended by a patient asking who they are and what their role is.

Have you ever been admitted to the hospital and been confused about who was providing your care? How did you handle it? What’s your advice to doctors to reduce the confusion?

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