July is an interesting time of transition in academic hospitals where there is a huge influx of brand new physicians starting their residency program as an intern. But there is also a shift in the residency program from previous years. This results in a new batch of junior residents, senior residents, chief residents, and a whole new batch of fellows. Everyone is eager albeit a bit nervous during these transition periods because it is a lot of change and learning new roles.
This hierarchy is quite purposeful. Each year you not only gain more training and experience, but you also gain more independence, responsibilities, and start mentoring younger residents. The hierarchy vaguely looks like this – intern, junior resident, senior resident, chief resident, fellow, attending physician. The constant force within this hierarchy are attending physicians.
Each service will have its own batch of attending physicians, fellows, and residents. Many of these services also utilize advanced practice providers (APP) such as physician assistants and nurse practitioners who can also evaluate, prescribe, and treat patients. APPs are also a constant force within the service as they do not tend to rotate services.
When a patient is in the hospital, they are assigned to a primary team/service. This team is huge and includes the whole hierarchy of physicians and APPs I just explained. Depending on what is going on with the patient, they will likely have other teams of similar structure consulting as specialists. For example, a patient may be on the cardiology service as their primary set of doctors. They may also have other teams to help manage specific complicated concurrent medical issues such as diabetes (endocrinology), kidney failure (nephrology), or a complicated infection (infectious disease). Depending on what all is going on with a patient, it isn’t uncommon for a patient can easily see a few dozen doctors a day while in the hospital. Sometimes they will see these doctors individually or as a team.
I’m not even going to talk about the plethora of other people a patient may see – nurses, nursing assistants, dietitians, techs, respiratory therapists, physical therapists, occupational therapists….it’s a lot of people coming in and out of their room all the time.
Obviously, it can get really complicated, really fast for both the patients and providers. It’s a lot of cooks in one very tiny kitchen. It’s overwhelming for patients and their loved ones on the best of days. When you throw in this whole transition period on top of it…it can be a fucking dumpster fire for all involved. There are often a lot of issues with miscommunication, time efficiency, and over/under treatment of the patient. Things just take longer because you’re herding cats and mistakes happen.
You can see, July is not the time you really want to be in the hospital. But medical emergencies don’t schedule themselves at opportune times. I really wish Dustin didn’t have this seizure in July. It made a shitty time even shittier.
I do my best to always meet July with patience and extra vigilance. But this year was different. I was in a totally different role – family member. As I said before, I cannot turn off the provider part of my brain. I found a new level of hyper vigilance I didn’t know I had. I also lost a lot of my patience during this time as well.
Beside you in time 