The Healthcare Team
It's important to know who's who when interacting with people in healthcare. There is a definite chain of authority and if you do not follow it, you lose credibility and possible access. Here are some of the key players you should know.
M.D.’s, doctors, surgeons, etc. are licensed by the state in which they practice. They assess your symptoms, order tests to figure out what’s behind those symptoms, hear your story to get clues to what could be causing the problems, and try to figure out the issues based on that information. They then make an educated guess regarding the diagnosis (which is why they “practice” medicine) and prescribe a treatment plan for you to include medications and therapies (treatments performed by other health disciplines).
Before a doctor can practice medicine independently, he/she must go through many years of practicing under the supervision of other doctors with more knowledge and skill in a training hospital (i.e., an academic medical facility). If you are a patient at an academic medical hospital, you will encounter the following additional “doctors.”
Note “Rounds” –
The term used to describe the parade of people that circulate from patient to patient daily finding out what’s new with them medically. During rounds, they find out what changed overnight, what new lab results came back, how’s the patient’s pain level, nursing concerns, patient complaints, etc. and determine what changes to make to patient orders. Rounds occur before doctor’s offices opening in the morning.
A Physician’s Assistant is a graduate from a PA school and licensed to practice under the supervision of a physician. A PA is able to write prescriptions and administer treatments just like a Nurse Practitioner but cannot do the same things a nurse has the authority to do. They are licensed by the Board of Medicine.
Medical Students are not doctors at all. They are in undergraduate training, very green, and just learning about medicine. They will ask you LOTS of questions, and later the attending physician grills the student on what they learned from you when they come back with a lot of other people to see you when they make rounds as a group.
Some specialties require an additional 1-2 years of focused practice before they can begin practice independently in that specialty. The additional years of specialty training are called “fellowships” and the residents are called “Fellows” while participating in them.
An Intern is a first-year medical resident. An intern is a recent graduate from college and is in the first year of graduate medical school. They work directly under the supervision of a faculty physician to learn to be a doctor. Though they can do the same things as a doctor, all work must be approved by the attending physician before implementation.
A Resident is in graduate medical education (years 2-4) Each year, they gain more experience and more independence under the watchful eye of an attending in the hospital. By their fourth year, they are practicing independently and ready to take their Boards to become “real” doctors. Most have been practicing in a specialized area of training.
Nursing Director-The Nurse Manager’s supervisor
Call the Nurse Manager if you have any issues you can’t resolve with nursing staff while your family member is a patient on a nursing unit. If you cannot resolve a problem with a staff member, contact the Nurse Manager directly with any complaints you may have. If it’s after hours (that’s usually after 5 pm or on weekends) and you have a problem, you want to ask for the Clinical Coordinator on the floor, or you want the Clinical Administrator for the hospital.
Clinical Coordinator –
The RN shift leader is usually called the Clinical Coordinator and supervisors the other staff on the floor. If you have a problem with whoever is giving you care, ask for this person to help you get a resolution.
Registered Nurses coordinate nursing care, teach patients, assess patient needs, administer treatments and medications. They perform many roles within the hospital setting and have many titles other than registered nurse when performing administrative roles when in non-clinical jobs. RNs control everything on the nursing floors and within the hospital’s nursing units. Here are some titles you need to know if you want to get things done in a hospital.
Licensed Practical Nurse (LPN)
Licensed Practical Nurse (LPN) – Licensed technical nurses, brings patients into rooms, do vital signs, assists doctors with procedures, helps with rooms setups and takedowns, may also do what nurses and care partners do. The difference between LPN and RN is in the amount of formal education they have acquired to practice. Most RNs have 2-4 years of intensive clinical education, which helps them to be better prepared to assess symptoms, determine a nursing diagnosis, create, and implement a nursing treatment plan.
Care Partners, (formerly called Nursing Assistants) – Support RN and LPNs in care and treatment of patients with the daily care needs of patients including hygiene, nutrition, mobility, vital signs, transportation, grooming, toileting, and much more. If you need anything for your comfort, ask a care partner to get it for you. They are your go-to person.”
Nurse Practitioner (NP), Nurse Midwife (NM)
Nurse Practitioner (NP), Nurse Midwife (NM) – Advanced practice registered nurses licensed to practice under the supervision of a physician and authorized to write prescriptions and administer treatments like a physician.
Clinical Administrator -May be called a clinical supervisor in some areas. Oversees larger areas of the hospital after hours to make sure everything is running well and helps to problem solve after leadership goes home.
Other Healthcare Service Areas
When you get your hospital bill, make sure that they have your correct insurance information. If you are paying something, they won’t take you to court; however, if you disregard their notices, they will sue you. Hospitals are a business. They need money to run. My recommendation is to contact the billing office if you have a large bill you need to pay and set up a payment plan right away. Set up what you can afford and make those payments on time, perhaps using automatic payments through your bank, so you don’t have to think about it. It’s the safest way to make sure they always get paid.
Registration or Admissions Clerk
Registration or Admissions Clerk – Registers you in each visit, collects co-payments, checks ID, goes over pre-admission paperwork, collects advanced directives, goes over forms for completeness, answers questions, helps you obtain access to others you might need to see. This person, however, does not have a lot of power. If you don’t like something, they tell you, don’t shoot the messenger. They are just passing along a message. It’s not personal. They have little flexibility.
Discharge Clerk – Schedules appointments, provides copies of discharge paperwork, much like the registration person, has little flexibility. They can be accommodating but are at the mercy of the person on the other end of the phone they are calling. They can’t give you what you want in most cases. You need to ask for their supervisor or the Billing Office if the issue is your bill.
Care Coordinator – This is the person who works with you to get ready to go home. They coordinate with you to find services for home health such as oxygen for home use, a home health agency, transportation home, or whatever you will need to get out of the hospital and home. You should have a case manager assigned to you shortly after admission. Smaller hospitals may use a Social Worker instead of a Care Coordinator. Both can do the same type of coordination.
Religious services for all faiths available regardless of preference. Let the patient relations office know of a desire for religious connection, and they will contact the chaplain’s office to set up a visit. Healthcare facilities recognize the importance of faith in the lives of their patients, and even if they do not have the service available on-site, they have connections with people of faith who can come in from most faith groups to meet with patients for support.
Physical Therapist – Helps persons perform exercises, stretches, warmups, and use equipment to strengthen and restore muscle in hopes of returning individuals to full function.
Respiratory Therapist – provides breathing treatments, sets up oxygen, draws blood gases, helps with ventilators, assists with helping people cough better, and assists with many other things related to breathing and lung care. Their state of residence registers them.
Occupational Therapist – Helps people perform exercises and learn to use muscles in such a way as to regain the capacity to perform daily life activities.
Evaluates an individual’s capacity to speak clearly, articulate correctly, say what they intend to say, swallow without choking, learn aspiration prevention tips, etc.