In the Hospital: Who Are All Those People?

You've just learned that you need to be admitted to the hospital to treat an acute illness or have a diagnostic procedure or surgery. The last thing on your mind is how to sort out the people who will be stopping by your room to check on your health status. In teaching hospitals like Froedtert - hospitals with affiliations with medical schools - there is likely to be an entire team of people who will help monitor your well-being and healthcare.

Teaching hospitals offer their patients a wealth of insight, technology and knowledge that might not be available at other facilities. The Association of American Medical Colleges (AAMC) says that in addition to providing routine patient care, teaching hospitals are "centers for experimental, innovative and technically sophisticated services." In addition, the AAMC notes, "Many of the advances started in the research laboratories of medical schools are incorporated into patient care through clinical research programs at teaching hospitals."

Because of the close relationship between the Medical College of Wisconsin and Froedtert Hospital, patients benefit from new, life-saving drugs, medical devices and breakthrough surgical techniques. More than 700 Medical College of Wisconsin physicians and 3,000 staff members are dedicated to excellence in patient care, research and medical education.

Medical College of Wisconsin physicians are consistently honored by recognition in "Best Doctors in America" and other local and national publications. Froedtert & Medical College patients benefit from a variety of medical and surgical specialists, working together in multidisciplinary teams and treating everything from the routine to the most difficult cases.

To make your hospital stay as comfortable as possible, it's useful to be familiar with the people on your medical team and what their responsibilities are.

The MD Care Team
Your healthcare team is always led by an attending (staff) physician who is responsible for your case. The team also consists of medical students at various stages of their education, and one or more interns and residents.

Attending physicians (also called staff physicians) go through a rigorous screening process before they are given privileges from the hospital to direct your care. They are the most senior doctors on your team and have overall responsibility for your case. Attending physicians oversee your treatment and supervise all the medical personnel on your team, including medical students, interns, residents and fellows. Attending physicians keep track of each patient's clinical progress and are always available to discuss care and treatment with you and your team members.

First-year medical students are usually in the classroom and not in the hospital. Second-year medical students may visit patients to gain experience by talking to you about your medical history and performing a physical exam, but they won't be involved in your day-to-day care. Third- and fourth-year medical students assist the attending doctor, residents and interns. They are often responsible for following up on test such as X-rays and lab tests and for ensuring that your care is running smoothly and as planned.

Medical students graduate and receive their Doctor of Medicine (MD degree) at the end of the fourth year of medical school. During their fourth year, the students decide on their choice of residency training in specialties such as surgery, pediatrics, internal medicine, dermatology or emergency medicine.

First-year residents (also called interns) are in post-graduate year 1 (or simply PGY-1) of a residency training program. This means they are in their first year after medical school. They will see you every day and are responsible, along with senior residents, for much of your day-to-day care. Interns will make routine care decisions about your treatment and the management of your case.

Residents (often referred to as PGY-2, PGY-3 or PGY-4, etc., depending on the number of years since medical school graduation) continue residency training in the specialty area of their choice. Residents, along with interns, are often your primary medical contacts and are an excellent source of information regarding your treatment. Residents and interns work under the supervision of the attending physician.

Residents, interns and students will usually visit you in the morning to check in and see how you are doing. Later they will meet with the rest of the team assigned to your case to discuss your current status. They are in frequent contact with the attending physician regarding your treatment and plan of care. The attending physician will typically stop in later in the morning, sometimes bringing other staff along.

Fellows (also known as subspecialty residents) have completed their residency training in a specialty area. At this point they are training in one of many subspecialties areas such as gastroenterology, cardiology or pulmonary medicine. Depending on the reason you are in the hospital, you might or might not have a subspecialist on your team.

Interns, residents and fellows have completed medical school and residents and fellows typically have independent licenses to practice medicine; they are receiving additional specialty or subspecialty training beyond medical school and are no longer students.

On-call physicians are available before and after regular hospital hours or anytime your primary resident is not available. For urgent matters, the on-call resident can always contact your attending physician - any time of the day or night.

Ralph M. Schapira, MD, is Professor and Vice Chair of Medicine at the Medical College and Chief of Medicine at the Zablocki VA Medical Center in Milwaukee. "In addition to all of the team members already mentioned," he says, "you might receive care from other doctors who are requested to do so by the physicians on your team - these are referred to as Consulting Physicians or simply Consultants. Doctors such as surgeons, anesthesiologists and quite a few others may visit you and communicate about your health with your attending physician and other team members."

Although there are some differences that can help you tell apart the various medical staff members (traditionally, many attending physicians wear long white coats and students wear short white coats), the most reliable way to know who is working with you is to ask them who they are or to check their identification badge - everyone must have one, and you have the right to ask to see it if it is not visible.

Patient Rights Are a Team Responsibility
"You should always feel free to ask about your care and any medications you are receiving," says Mahendr Kochar, MD, MS, MBA, Medical College of Wisconsin Professor of Medicine and Senior Associate Dean of Graduate Medical Education. "Patients should never feel they are a bother for asking questions of the staff," he emphasizes. Recent media reports point out that despite enormous efforts to guarantee patient safety, mistakes still happen. "It's very important that patients remain vigilant," Dr. Kochar notes. "They can help prevent medical errors by discussing their treatments and medications and by understanding when and how much they should receive."

Coordinated Care
Of course, you will also be under the care of nursing staff and other health care professionals such as respiratory, physical or occupational therapists, as well as social workers, dietitians and pharmacists. Some of these individuals may come to visit you, too.

Even though organizing the various medical staff members might seem complicated, says Dr. Schapira, "everyone works together. Don't forget that your attending physician works closely with all staff - including the consultants - and coordinates your health care." If you ever feel that the information you are receiving is unclear, address your concerns with your attending physician, who will be able to give you authoritative advice. The name of your attending physician should be listed clearly on your wristband, or another care team member can provide it for you.

Eileen Early, BA, BSN, RN
HealthLink Editor

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.