The Inner Workings of Teaching Hospitals
Teaching Hospitals (University Hospitals)
If you’re expecting to go to a private hospital, this isn't for you. In a private hospital, you have one doctor, one nurse, and maybe a nurse aid. Very straightforward and simple.
A teaching hospital, however, is a whole different world. Your doctors will change on seemingly an hourly basis, you’ll be told conflicting stories by different doctors who can’t and don’t seem to talk to each other, etc.
Having spent most of my nursing career in university hospitals, I’ll give you a small glimpse into the inner workings of the different “teams”.
The Swarm (AKA: Rounds)
So, you've been admitted to the hospital overnight, and it's roughly 5-7 am, a doctor comes in to talk to you. This guy is nice. Likely fresh faced and newly graduated from medical school. He might not be able to answer all your questions. I call this one the scout. He drew the short stick today, and he’s laying eyes on you to report back to the rest of the team.
This team consists of one attending physician (the boss), 1-2 fellows (the underboss, soon to be boss), and residents of varying years (the underlings). Your attending is ultimately responsible for you, even though you might only see him once or twice during your stay. All the other people (you won’t remember their names), report to him, either directly or indirectly.
So your attending is the full fledged, can practice on their own, doctor. He has been through school and the 5-11 years of residency (depending on the field). Your fellow is just a step below him. A fellow has completed most of their residency and is 1-3 years away from being an attending. This person is now specializing in whatever type of medicine the team practices.
The residents are all medical school graduates, and have varying degrees of real life experience. Some are fresh out of the classrooms, and these likely won’t be responsible for sick patients. Others may be nearly as knowledgeable and experienced as the fellows.
-The bossman. This is the person responsible for your care.
-Has completed medical school and residency.
-Is over all fellows/residents on your service.
-Nearing the end of residency, soon to be an attending.
-Has completed medical school.
-Is training in their specific field now.
-Has completed medical school.
-Encompasses years 1-5 of post school training.
-Reports to fellow and attending.
-Rotates among different services for various training.
Your nurses role in this system is many fold. They are responsible for you on a moment to moment basis. If you do something bad, intentionally or by accident, they are responsible. They’re also responsible for double checking all orders written by your team.
You can view your nurse as the barrier and facilitator between you and the rest of the hospital. If an order is written that doesn’t make sense (at first glance, at least), your nurse will talk with the doctors to find out what the goal is with that order. They’ll talk to pharmacy to clarify meds, institute said orders, etc.
As for the facilitator role, you need better pain meds? They’ll talk to the pain team or the managing doctors. You need some financial support? The nurse will contact social services or case management. Need help with supplies at home or extra teaching? Guess who you’d talk to..
On this note, let me say, be nice to your nurses. They do a lot more for you in the background than you realize (I might be biased on this point).
So far we have your primary medicine team, which includes your Attending (The boss), a fellow or two (near the end of training), and various residents, as well as your nurse. Not only do you have all the above mentioned dynamics, but you could have several different medical teams taking care of you.
So, lets say you have a clot removed from your leg. Vascular surgery takes out the clot and will manage the wound and your leg. Maybe the post surgical medical team manages everything else and writes most of your orders. Oh, did your heart do something strange? Better bring in the cardiology team. Then you have the various support services that will help with you, including respiratory therapy, who will just focus on your lungs and lung health, physical therapy, radiology techs, etc.
It is confusing, but it truly isn’t a bad system. Sometimes the nurse will struggle to get everybody on the same page, but it’s always easy to contact and get help from a doctor if needed in this system.
I could go further into the hospital dynamics by including charge nurses, rapid response, house officers, etc.. but really, it’s all mostly background noise. Just remember that, just because you see a new face every 30 minutes, doesn't mean you aren't being tracked by your doctors. They all report up to the same person.