Picture this: You're lying in your hospital bed, feeling vulnerable, in pain. You ask your nurse to give you something to alleviate your pain. Eventually someone shows up, carrying official looking paperwork (maybe even a small computer) and introduces herself as "Dr. Brown." She begins asking questions. She tells you she'll be right back, and you feel some relief that your pain will be alleviated soon. You have hope she can help you in the hospital.
An hour later, you're in more pain than ever - excruciating.... where are those pain meds?
There are at least two reasons you haven't gotten what you need to relieve your pain. The first problem is staff identification. The second is responsibilities and oversight.
Identification - Who's Who?
In the past, you might have relied on a white coat to tell you someone was a doctor, or a starched white cap to signify a nurse. These days those lines are no longer clear. Most hospital personnel seem to wear scrubs. Many doctors breeze in and breeze out of patients' rooms wearing no coat at all. In fact, those coats are now considered culprits in the war on hospital infections and are being banned in some states.
Several states have enacted regulations that require hospital personnel to wear name badges that are clear, including large dark type, so that patients can tell who is actually helping them. The idea is that when we are sick, and possibly taking consciousness-altering drugs, we are vulnerable, and we need clear information about who is caring for us. In states that aren't regulated, some hospitals have begun providing name tags on their own.
A seemingly simple solution - and a good start. But it doesn't go far enough.
Responsibilities and Oversight
Even if a name tag says "doctor," it may be worn by a student who has earned the title, but doesn't have the knowledge or skill level to perform those responsibilities. Four years of medical school provide the credentials to be called "doctor." But then students are thrown into the fire - hospital patient responsibilities - and maybe they know what to do, and maybe they don't. Book learning, and reality, are often two different things.
No one knows this better than Helen Haskell whose son, Lewis Blackman, died because he was treated by a "doctor" who was a student. Lewis was the victim of the most frequent safety violation in American hospitals, a drug error, which was compounded by misdiagnosis, both of which were the fault of a resident, a student doctor, who Helen mistakenly thought was an attending doctor (meaning, a full-fledged, licensed physician.)
Since Lewis died, the Lewis Blackman Act was passed in South Carolina requiring hospital doctors to wear name tags that identify them according to their level of expertise ("resident" or "attending).
But the distinction between student-doctors and full-fledged doctors is not labelled clearly on ID badges in many hospitals across the US. Those hospitals have no incentive to let you know who is a student versus who is an attending. They can staff with many more student doctors who get paid far less than attendings. They don't want patients demanding to see someone who is more expensive for them to employ.
What can we patients do to get what we need from the right people in the hospital?
Back to the story that started this article: it turns out that "Doctor Brown" was wearing an ID badge, but it was turned around. Further, Dr. Brown is a first year resident. You needed pain relief that she needed permission to provide. You're still in pain, because the person you asked can't provide what you need.
Here are some ways you can be sure you'll get what you need in the hospital from people who can provide it:
• Begin by learning the roles of the many people you will come into contact with in the hospital. From nurses to nurse practitioners, to physician assistants, to hospitalists, interventionalists and others - be aware of their ability to help you get what you need.
• Look for identification on each person you encounter in the hospital. If they have an ID badge, but it's turned around so you can't see what it says, then ask them to turn it face out.
• If you are requesting something that affects your medical status, then be sure the person who is tasked with helping you has the ability to do what needs to be done. A medical assistant can certainly accompany you to the bathroom, or adjust your bed to make you more comfortable. But it may require a doctor, or a nurse or resident with access to an attending to prescribe a controlled substance for pain. If you aren't sure whether the person who arrives at your bedside can provide what you need, then ask, "Is this something you can do? Or do you need to get an order from someone else?" If they need to get that order elsewhere, then ask them to report back to you as soon as that has been accomplished so you know when (or IF) it will be taken care of.
• If the provider who shows up to help you has DOCTOR on his badge, then be sure to confirm his status. Ask "Are you an attending?" If the doctor says NO, that he or she is a resident, then you'll need to determine if you want to ask for help from someone with a higher level of expertise. In some states, this won't be necessary because the badge will be specific (see the notation about South Carolina above.) But the chances are you won't know for sure, and your life may depend on it.
• Be aware, too, that the calendar affects how often you'll need to confirm the identification and credentials of the person who might be able to help you. Hospital staffing may be affected by holidays and weekends. July is a particular problem for academic medical centers. If you must be hospitalized during those times, then be extra vigilant about tracking who is tasked with helping you.
Knowing that the person who you expect to take care of your needs in the hospital does, in fact, have the ability and credentials to do so, can go a long way toward making sure your hospitalization yields your best outcomes.
