KEEPING YOUR FAMILY SAFE
HOW TO COMMUNICATE WITH THE HEALTH CARE TEAM IN A HOSPITAL
When a loved one enters the hospital, the family may find themselves in an unfamiliar, confusing environment as they try to help their loved one. Afterwards, they sometimes tell me that (1) it was difficult to speak to the physician, (2) they had questions that were not answered, and (3) they didn’t know how to get answers.1
The problem is nationwide. A recent study found that 29% of patients in a hospital did not know who was in charge of their care. That shouldn’t happen. In my practice as an attorney helping injured clients, I have studied how hospitals work, the physicians that practice there, and how best to communicate with these physicians. I now share this knowledge with you, and explain the importance of nurses, social workers, and case managers in the hospital communication process. I hope that this will make a hospital stay for a loved one easier on your family.
A. What types of healthcare providers might care for your family member?
Hospitals can be very confusing places. They have their own systems, operating procedures, and jargon. Some clients tell me that it feels like they are in another world.
This also pertains to the medical staff. To some incoming patients and their families, it is difficult to tell who is who, what each provider in a white coat is doing, and why. Here are some of the medical providers that your loved one as a patient may encounter during a hospital stay.
The attending physician has overall responsibility for the patient in the hospital. He admits and discharges the patient, and may ask specialists in orthopedics, cardiology, and surgery, among others, to treat the patient.
The specialists called in by the attending physician are called consulting physicians. They treat a particular ailment in the patient. For example, a patient admitted for back surgery may suffer decreased kidney function. The attending physician surgeon may ask a kidney specialist to consult on, or treat that condition while the patient is in the hospital. The consulting physician’s role is usually limited to the specific condition or ailment that prompted the consult.
Teaching hospitals are associated with four-year medical schools. During the first two years of medical school, students learn about diseases, anatomy, and treatment. Patient contact is limited. During the next two years, medical students observe at these teaching hospitals, but are not responsible for patient care. After graduating from medical school, the students enter a residency program. It teaches medical students practical clinical skills. First year residents are called interns. The residency programs start on July 1 of each year, and are divided into specialties such as pediatrics, surgery, or orthopedics. First year residents follow a general training program at a hospital. They may spend five weeks in the emergency department, six weeks in the intensive care unit, and then move to pediatrics and obstetrics. In residency years two and three, residents concentrate on their chosen medical specialty.
Residents, medical students, and teaching physicians often travel as a group to see hospital patients. A physician may also visit the patient in the hospital alone. This is called “rounds” or “rounding” on the patients. Residents “on call” stay at the hospital overnight to care for patients. This means long hours and weekends with little sleep for the residents. Residencies last three or more years.
A hospitalist is a physician that works only at the hospital and sees only hospital patients. Hospitalists work different shifts. A hospital may have hospitalists on duty 24 hours a day. The hospitalist writes orders, calls consults, and directs care as needed. The hospitalist may be the attending physician for the patient during the hospitalization. Hospitalists usually communicate and report status to the attending physician, or the incoming physician.
The intensivist is a physician that treats critically ill patients in settings such as the intensive care unit.
Physician’s assistants and nurse practitioners are not physicians. A physician’s assistant may practice medicine only when supervised by a trained physician.2 That physician must continually supervise the physician assistant’s care of the patients. However, the supervising physician need not always be physically present at the hospital during such care.
A nurse practitioner is a nurse with advanced training and certification. She diagnoses illness and physical conditions and performs therapeutic and corrective measures within a specific medical field. However, the nurse practitioner can only do this if she collaborates with a physician or medical facility in the field on such treatment.
Physician Assistants and Nurse Practitioners are sometimes called “physician extenders.” They may work for the hospital, or a medical practice group, that sees patients in the hospital.
The registered nurse assigned to the patient is a critical part of the hospital treatment team. As a patient advocate, she is the first point of contact for information about the patient and the treatment plan. The registered nurse will also contact physicians and social workers for the patient or the patient’s family. As a result, registered nurses are often an invaluable resource for family members. However, the registered nurse cannot independently advise on medical matters, or diagnose or treat the patient. That information must come from the physicians, as the registered nurse will indicate. Therefore, for questions about medical advice, diagnoses and treatment, the family should talk to the physicians directing the patient’s treatment plan.
B. The New York State Patient’s Bill of Rights – and why it can help
The New York State Patient’s Bill of Rights3 requires that a hospital provide the patient with the name and position of the physician in charge of the patient’s care. The patient has the right to discuss the care with that physician. The hospital must advise the patient of any change in health status, including harm or injury, the cause for the change, and the recommended course of treatment. The patient must also receive complete information about his diagnosis, treatment and prognosis, and any information needed to give an informed consent. The physicians in charge of the patient’s care should inform the patient of these facts. Knowing that a patient has these rights can empower the patient’s family to receive this critical information during the loved one’s hospital stay.
C. Suggestions for Communicating with your Loved One’s Health Care Team in the Hospital
After finding out the physicians in charge of the patient’s care, family members then should meet with those physicians. This can be difficult. Physicians are very busy. They follow a regimented schedule. Therefore, it is often best to speak with them when they round on the patient either early in the morning, or in the evenings. The registered nurse assigned to the patient should tell you when the doctors will round.
When meeting with a physician, consider having family members on hand with a designated spokesperson. Prepare questions beforehand in a notebook and then write down the answers in the notebook. Ask specific questions related to the treatment. If more time is needed, ask the physician if she can further discuss it later. Get the phone number and time of day that is best for such contact. Put that in the notebook with the name and direct dial phone number of the doctor’s assistant.
Hospital social workers and case managers are a second vital communication link with hospital physicians. They can arrange a meeting with the treatment team. This may include the attending, consulting and hospitalist physicians, nursing, and family members. Sometimes, the physicians will first meet to discuss their impressions and treatment notes, and then meet with the family about the patient’s condition. In closing, remember that you as the patient’s family, the nursing staff, and the hospital physicians share a common goal — your loved one’s recovery. Therefore, approach communications with the hospital medical providers and the nursing staff from this shared vantage point.
1 This article assumes that the patient family member has given appropriate authorization to the hospital care team for other family members to discuss the patient family member’s medical care and treatment. Medical providers will correctly decline to do so absent such appropriate authorization.
2 See Education Law §6540, 6541 at http://www.op.nysed.gov/prof/med/article131-b.htm
3 https://regs.health.ny.gov/content/section-4057-patients-rights. See 10 NYCRR 405.7(c)(1)-(21) which contains the language of the Patient Bill of Rights. The Hospital must post it “in a conspicuous place.” See 10 NYCRR 405.7(d).