Being admitted to the hospital is confusing and scary enough. There is a flurry of activity to address your medical needs, diagnose and treat your problem, along with administrative tasks. Then, there’s getting you settled into a room. Lots of new faces start showing up to poke and prod you, ask you lots of questions and run tests. It can be overwhelming and feel intrusive.
However, once the dust settles, you might feel confused. You may ask yourself, “Who’s taking care of me, anyhow?”
This blog post will empower you with information about the people who take care of you when you’re in the hospital. And, hopefully, lessen the confusion around three important questions:
- Who is on my care team?
- Who has ultimate authority and responsibility for my medical care and me?
- Why do the people who care for me change so often?
Plus, you can download our free Care Team Chart where you can write down information about the team of people who are taking care of you while you’re in the hospital.
We will focus this article on when you are admitted to what’s called a “teaching” hospital, which is a hospital that educates and trains physicians at varying levels of experience. These physicians make up an important part of the care team, but, also, make care teams more complicated and confusing, at times, to patients and families.
If you are admitted to a community hospital, your care team will not be as complex. However, it can still be challenging to understand all the various people taking care of you and know what role each person plays.
Your Care Team:
Who’s taking care of me?
Hospitals are made up of many types of teams. Most of these teams are collections of professionals with a certain medical focus area. For example, there are teams of physicians by specialty like:
- hematology (blood);
- oncology (cancer);
- nephrology (kidneys).
There are teams centered on functions (or departments) that represent treatment and testing services like:
- radiology (imaging);
- pharmacy (medicine);
- physical rehabilitation (movement and strength);
- respiratory therapy (breathing);
- phlebotomy (blood collection).
Your care team will be made up of professionals from several teams, depending on your diagnosis (problem you have) and treatment plan (method to help you get better).
It is important to understand how teams function in a hospital. They are very hierarchical, meaning that it is clear who is in charge and who is the boss of whom.
This chart shows the structure of a typical teaching hospital care team.
- A Hospitalist
- The Attending Physician and his or her team
- Consulting physicians
- Nursing staff
- Treatment professionals from various departments
Let’s look a little more deeply at each group.
Attending Physician’s Team: Your Attending Physician is the “quarterback” of your entire care team. This physician is the one who agreed to admit you. (Yes, a doctor has to agree to treat you.) How this physician is chosen is affected by a lot of factors.
Consulting Physicians: These physicians have been asked by your Attending Physician (or team) to advise on your diagnosis and treatment plan based on your symptoms and his or her special medical knowledge.
Nursing Staff: Nurses make up the team who care for medical and non-medical needs that you have as well as coordinating many aspects of care and treatment.
Treatment Professionals: These professionals include all the various technicians and other specialists who help carry out the therapies your physicians have ordered for you. They may include physical therapists to help you with strengthening or walking. Or, it may include respiratory therapy that will help with your breathing. Or, it could include wound care that ensure that any wounds you have are healing and being addressed correctly. There could be others that come and go during your stay as they help with carrying out the orders your physicians requested as part of your treatment plan.
The Role of Hospitalist: There is one very important role that is part of the modern hospital care teament. That is the physician who does not focus on a particular medical area (specialty, disease or body system), but is focused on the location of where care is delivered. A hospitalist is a physician who specializes in inpatient medicine. This role first emerged as part of hospital care teams in the late-1990s.
In many ways, the hospitalist is a bridge from the inside of healthcare (hospital) to the outside of healthcare (primary care). The hospitalist, also, helps determine what medical services outside of the hospital, including transfers to a nursing home, may be needed.
Responsibility and Authority:
Who’s in charge around here?
Your care team has several leaders who are responsible for your care. Although everyone giving you care should take responsibility, there is one physician who is, ultimately, responsible for your safety, health, wellbeing, and satisfaction. Your Attending Physician is the person leading your entire care team. He or she is responsible for your care and safety. This is the physician who took responsibility for you upon admission. Your Attending Physician may be your personal physician; someone you already know. But, this could also be a new physician that has never cared for you before. It is very important that you document the name of your Attending Physician and know how to reach him or her if you have questions.
As you look at the chart, you will see that it is organized so that certain people are at the top who organize and oversee the work of others below them. Under your Attending Physician is a team of physicians-in-training, as well as other professionals who are delegated authority from this senior physician. This team will make up the core of the medical care you receive.
Why does my care team change so often?
Just when you’re getting your bearings in the hospital and becoming used to the change of environment, food, lack of sleep, and the group of people who are taking care of you, you might feel you’re back to square one. Your care team changes.
You may ask yourself, “Now, who are all THESE people? Where did my Attending Physician, Dr. Mary Smith, go?”
Because the various teams in the hospital work off of different schedules, your care team could change. Some members on your team may change more regularly than others. Here are some general guidelines around how often each role on your team may change.
Physicians – In a teaching hospital, physicians may be “on service” (meaning that they are actively seeing and treating patients in the hospital) for several months out of the year. Typically, they actively treat patients there for one to two weeks at a time. For physicians furthering their education, like residents and fellows, they “rotate” from different medical specialties throughout their education within the hospital. Typically, they are with one specialty area for one month at a time.
The Attending Physician could, also, change during the hospital stay if the patient is transferred to a higher level of care. If a patient is admitted to the hospitalist, but then gets transferred to an Intensive Care Unit (ICU), the care for that patient, typically, transfers to the ICU physician. This physician may may be identified as a Critical Care or Pulmonary Critical Care Medicine attending physician. They would take over responsibility for the patient during the time he or she is in that unit and requiring a more intense level of care.
Hospitalists – Some large primary care practices may rotate their physicians as hospitalists at area hospitals where most of their patients are admitted. Alternatively, primary care physicians may have specific hospitalist groups that they admit their patients to when their patients need inpatient care. If a patient does not fall under either of these scenarios, they would be considered “unassigned” and a hospitalist service is often assigned to care for the patient.
While it used to be more common that primary care physicians would admit directly to a hospital, many times that is now coordinated with a hospitalist.
Nurses – Nursing staff change in a different way from physicians. They change by “shifts” or when their workday begins and ends. Typically, they work 10-12 hours before a new nurse takes their shift. Nurses, also, tend to change over weekends and holidays if there is adequate coverage for more experienced nurses to take vacation days. Nurses should overlap their shifts by 30 minutes or more so that they can provide a “hand off”, which means that they share information about the patient so that the new nurse is updated.
Treatment Teams – Depending on the treatment team, you may not notice a change. Sometimes the individual caring for you from a particular team changes as you get better and you don’t require as experienced a technician. Other times, there are changes because the team is caring for more patients on another floor of the hospital.
What Can You Do?
Four Tips for Better Hospital Team Care
To help someone in the hospital understand their care team, know who is responsible for them and be aware of the potential for the care team to change, here are four tips:
1. Ask the question, “Who is MY Attending Physician?”
This is the physician who is ultimately responsible for you. If you have serious concerns about the treatment plan or questions that are not being answered to your satisfaction, ask to speak with him or her, personally.
2. Ask to meet your Attending Physician.
You should know his or her name and personally speak about your diagnosis and treatment plan.
3. Use the Care Team Chart (download pdf for free)
- Document your Attending Physician’s name and the name of the resident or fellow who is primarily taking care of you. Also, write down the medical specialties using the handy key on the chart so that you know what areas are being consulted as part of your care. Write down as much detail as you can about the other physicians on your Attending and Consulting teams in each area.
- With each key person you document on the chart, it’s a good idea to make note of the best way to get in touch with him or her in case you have concerns or questions. It may be suggested that you make a request through your nurse or you may receive a business card or phone number.
- Next, use the chart to know who is the nurse in charge of your unit where your room is located. Although your bedside and shift nurses may change, the Nurse Manager of the unit shouldn’t.
- Lastly, write down the type of treatment teams who are going to be involved in your care. If you can remember, mark the first name of the person.
4. Update Your Care Team Chart
As your team changes, check-in with the new person and ask a few questions to be sure they are aware of key information about you. This can help eliminate errors and fill in important details about you, as well as your preferences for care.
By understanding these three ideas – how hospital teams work, who is the “quarterback” over the care team, and why the people who care for you change so often – you can feel more confident about who you should speak to if you have questions or concerns. You can have less anxiety about the flurry of people who you’ll meet and, hopefully, have a better and safer hospital stay.