At a large hospital there are usually many health care workers. If you are a patient at a large hospital you will interact with many members of the health care team. At times it can be very confusing and frustrating to deal with all these members of the team. This article is designed to help explain the roles of the various members on the doctors side of the hospital.
Lets start at the top of the heiarchy!
THE ATTENDING:
An attending is a doctor who has finished training and practices in a certain field. For example, a nephrology attending is a kidney doctor. If you are in the hospital and have kidney problems, chances are a nephrology attending will be contacted to help manage your kidney care.
There are attendings for every field of medicine and surgery (neurosurgery, dermatology, family medicine, pathology, etc...). If you are at a large hospital and have multiple health problems you might have multiple attendings helping in your care. It can get confusing with multiple doctors trying to provide care for one patient. That's why it is important as a patient to know who your "Main Attending" is. Your main attending will be the doctor who helps coordinate all of the other attendings and ultimately has the final decision making ability for you, the patient.
For example: Lets say Mr. Bob Smith gets admitted to the hospital for pneumonia. He will likely be admitted under an Internal Medicine Attending (lets say Doctor "A"). This doctor will be the main attending and dictate the vast majority of care for this patient. Lets also say that Bob Smith has diabetes and needs help managing his diabetes medications. Bob's main attending might ask another attending who specializes in diabetes care to consult on Bob and provide recommendations. Now Bob has two attendings helping to take of him but still Doctor "A" has the final word on his care. If Bob has other problems, his main attending might ask even more attendings to get involved from other specialties to provide the best possible care for Bob.
Therefore, it is VERY IMPORTANT that a patient and the patient's family knows who is the main attending. That way, if there is an question or confusion, the patient has just one doctor to go to for guidance.
To make things more confusing, each attending might have one or multiple Residents. Read on to learn what a resident is.
THE RESIDENTS:
A resident is simply a doctor in training. When someone graduates medical school, they officially earn the letters M.D. and thus are doctors, however, they still have alot of training to complete until they practice on their own. Therefore, after medical school, all graduates enter into a residency program. Programs include every area of medicine and surgery including internal medicine, general surgery, orthopaedics, psychiatry, dermatology, etc... Some programs like medicine are 3 years whereas other programs like general surgery are 5-7 years long.
A resident will be supervised by an attending. Lets say Bob needs surgery for his gallbladder while he is in the hospital. Chances are the surgery Resident will be called to see the patient. The resident will assess the patient and then go report his or her findings to his surgery attending. The surgery attending will then assess Bob and make the final decision on whether the patient requires surgery.
Confusion arises because there are often many residents under each attending. However, all of these residents work for a specific attending and all those attendings communicate with the main attending to provide care for the patient.
From a patient's point of view, residents can appear as in-experienced doctors in training that might make patients nervous. However, residents are important part of providing high level of care at a large hospital. Patients have near immediate access to residents and these residents must report to their attending supervisors. Therefore, patients should work with residents because this is the fast and easiest way to get good communication to the experienced attendings.
