I recently went to Tucson Medical Center to visit a loved one.  She is an out of town visitor who, unfortunately, needed urgent medical care and hospitalization. 

This made me think how bewildering this process is to a patient and their family.  Who are all these people coming into the room?  What are their jobs?  This blog will attempt to provide a brief description of the process, including the caregivers who make it work. 

First Choice: Hospital or Urgent Care?

My family member had significant abdominal pain, was ill, and had a fever.  After talking with her, I thought she needed to get medical attention.  Where to go?  Urgent care facilities are great for minor problems, i.e.:  ear infection, stitches, flu, sprains and strains, and the like.  When a person is potentially very ill, may need special tests, or may need to stay in a hospital, then a hospital's Emergency Department is the way to go.  In her case, because she was having potentially serious problems in her abdomen, she likely was going to need testing and maybe an abdominal scan, like a CT scan or ultrasound, to figure out what was going on.  I recommended she go straight to an Emergency Department at Tucson Medical Center. 

Step One: The Emergency Department

Most folks are admitted into the hospital by going to the Emergency Department.  At the Emergency Department, she was first assessed by a triage nurse.  This person categorizes how urgently a patient may need to be seen.  A person with chest pain needs to be seen quicker than a person with an ankle sprain.  After waiting a bit, she was taken to a room, where she was seen by a nurse.  Some routine tests were run, including urine and blood tests. She was sent for a CT scan.  She was then evaluated by an Emergency Department physician.  After evaluating her, including reviewing her testing and the report from the CT scan, the Emergency Department doctor determined she needed to be admitted into the hospital for further care and possibly surgery.

Step Two: Hospital Admission and Further Evaluation

At this point, her care was transferred from the Emergency Department to one of the areas of the hospital.  The hospital is roughly divided into various sections based on the type of care a patient needs.  Children are taken to the pediatric unit.  Heart patients are taken to the telemetry unit where they get special monitoring.  Neurological patients are taken to the neuro unit.  Very sick patients are taken to ICU or intensive care.  My family member was admitted into the Medical/Surgical unit.  This is where many, varied type of patients who may need surgery are cared for. 

Once admitted into the hospital, a doctor called a “hospitalist” was assigned to her.  Years ago, a general practice doctor would take time out of her day and visit her patients in the hospital.  Now, with compartmentalized medicine, this task has been taken over by doctors who only work full time in the hospital -- hospitalists.  The hospitalist is the quarterback for the patient's care.  He orders medicines and determines what specialists need to see the patient, and with the specialists, determines what care is needed.  If you do not know who to ask about a concern, you can always go to the hospitalist. 

In my family member's case, the hospitalist ordered that a general surgeon evaluate her.  So, now she has two doctors: the hospitalists and a general surgeon.  General surgeons do not just do surgery.  They also evaluate a patient to diagnose what is wrong with them, and help decide what care they may need, including surgery.  The general surgeon visits her at least once a day and makes decisions about what care she needs.  If all is working as it should, the general surgeon consults with the hospitalists to coordinate the plan of care, in this case, including whether she needed surgery.

If a patient has more than one medical problem, then the hospitalist will order that additional specialists see the patient.  For example, a patient with heart and lung problems will be seen by a pulmonologist and cardiologist.  A patient with a difficult infection will be seen by an infectious disease specialists.  The hospitalists should coordinate all this care and testing. 

Nurses play an integral role in this process.  Nurses are the eyes and ears for the doctors.  They should report to the doctors how the patient is doing.  Importantly, they should inform the doctor if there is a change of condition that requires urgent care.  So, if you have a concern your or your family member's condition has changed, you need to voice it clearly and definitively to the nurse and ask she be evaluated by a doctor. 

I have written many times on this subject, but it needs repeating.  A family member's job in this process is to act as a patient's advocate.  Start a notebook and write down key information.  Who are the doctors?  What tests are being run?  You need to make sure the doctors are coordinating their care.  You need to know what medicines the patient is getting, and why they are getting them.  Write this down.  You need to understand what tests are being run, why they are being run, and what they showed.  Write this down.  It is ok to ask questions, and if you do not understand the answer, ask again.

Unfortunately, medical errors are all to frequent in modern hospitals.  By being an advocate, you may be able to catch a mistake before it can cause harm.  It is much better to correct a medical mistake before it causes harm, so you never need a medical malpractice lawyer after it is too late. 

Step Three: Discharge

While we are not there yet, eventually, the decision will be made to discharge my family member.  This decision is made jointly by her surgeon and hospitalist.  Undoubtedly, they will recommend she take certain medications and have certain tests.  It is important the family clearly understand what these follow up instructions. 

I hope this blog helps clarify the unfamiliar process that a patient is thrown into at a hospital.  The bottom line is every patient needs and advocate to help them navigate this novel situation.