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Tuesday, June 17, 2014

Doctor Who?

I'll be the first to admit it - doctors are terrible at introductions.  If you go to any major hospital that trains young doctors or works with a medical school, known as a "teaching hospital," you will likely be taken care of by a boatload of twenty-somethings who all look very similar and introduce themselves once and assume you will instantly remember their names and jobs.  

Please do not feel bad asking someone to introduce themselves again or simply saying, "Remind me who you are again?"  or "What was your name again?"  Believe me, I do this every day with nurses, other doctors I don't work with often, as well as patients and their families.  The hospital is a much safer place when you know who your team is!  

If you are in the hospital and on a "teaching service" you are being taken care of by young doctors in training and medical students.  Here's a breakdown of your very large team:

Intern - this is the title given to a doctor (MD or DO), who just graduated from medical school and is in her first year of training (called residency).  Often, this is your primary doctor in the hospital.  This is usually the doctor talking to you and about you the most and who also knows many intimate details like if you had a fever overnight and how many times you peed.  This person also comes to your room very early in the morning and examines you, and hopefully talks to you.  The intern also changes your medications and orders tests for you in the computer system.  
NOTE: intern is easily confused with internist - who is a doctor for adults.  They are usually not the same thing, unless you are in a hospital for adults and being taken care of by a first-year doctor.  

Resident - A resident is any doctor in a training program; so an intern is a resident.  However, this title is usually given to a doctor who has finished his first year of training and is now helping the intern out or working on a team with other 2nd and 3rd year doctors-in-training taking care of sicker patients.  
NOTE: Senior Resident - This is the doctor who usually comes to see you if your intern is worried about you and is also there when the big team comes to see you in the morning.  This person is responsible for knowing the major details and plan for all the patients the team takes care of (which can be over 10 people) so this doctor does NOT know all the little details about you and needs to work with the intern and nurse (and may ask you questions you already told your intern) to help with your care.  This doctor usually has more experience with patients who are very sick than the intern.

Fellow - A fellow is a doctor who has finished her general training and could take care of adults or children in the community, but has decided to focus on a specific disease (like kidney disease or cancer) and is doing some extra training.  This person has completed his residency and has at least 3 years of doctor training already.  Most fellows you will see in the hospital are in their fourth year of training (unless it is a surgeon) and that is usually the first and only year she will be in the hospital.  A fellow usually spends the other 2 years doing research or a project and is not often in the hospital.  This person, like the supervising resident, knows a lot of the big picture and some important details about you, but still not the same details as your intern.  

Attending physician - sometimes just called "the attending" this is the doctor who has completed his training and is in charge of the team.  On a general team, this person has at least 3 years of experience (and may still look pretty young), on a more specialized team (like the liver team), this person has at least 6 years of training (and again, may look young).  This person has a lot of experience, but manages the whole team, and needs to work with the doctors in training to help take care of you.  

Medical students - medical students are people in school to become doctors.  Most of the students you see in the hospital are in their 3rd and 4th years of school and deciding what kind of doctor they want to be.  This person should always introduce herself as a "medical student" or "student doctor".  Written out, this person may have MS3 or MS4 behind his name, instead of MD or DO.  The medical student may see you and talk about you to the doctors on the team, but cannot order medicines or tests.  The medical student is always working with an intern or resident to learn how to care for you.  This person also has the most time to spend with you and does a great job presenting lots of details about you.  

Consultant - A consultant doctor is usually with extra training is a specific body part (like a infectious disease doctor), who does not run her own team.  She gives your doctor team advice, usually about a specific question (like which antibiotics are best for you) - often a fellow is part of a consultant service.  This may also be a surgeon or interventional radiologist, who will do a procedure that your regular team does not do.  This doctor usually makes suggestions to you team, but does not order tests or medicines for you.  

There are lots of other wonderful people who are part of your care team including your nurse, maybe a respiratory therapist, social worker, or chaplain.  They are very important and hopefully working well with your doctor team.  Sometimes its hard to remember who is who - so don't hesitate to ask!

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