Being an Advocate in the Medical World: Understanding Your Medical Team

Imagine the scenario of your child being taken in an ambulance, going to the Level One Trauma room, and being surrounded by men and women in different color scrubs, white coats, and them telling you what they think is best for your child. It’s overwhelming. Not only are you in shock, but you’re having to receive information from complete strangers. 

Understanding your medical team is vital to becoming the best advocate for your child. It helps you, it helps them. It helps you know how to channel your energy, make decisions, and give respect. Understanding their role, position, expertise, is all extremely important in seeing where they’re coming from so then you can make the best decision for your child.

Doctors & Titles

One of the things that my husband and I had to learn while Paige was in the ICU is what the different titles mean. We got used to the nurses and therapists pretty quickly – they don’t walk around in white coats. But when you have someone in a white coat, called Doctor, say “Well I’m not the one who makes those decisions” it can be very confusing. Hearing things like “I’m the resident for this floor” or “I’m the attending for the week” can tend to leave you hanging. What do all these titles mean? 

With the help of my awesome connections in the Texas Children ICU, here are some easy ways to remember what the different titles are.

A Resident

Residency is that gap between finishing college and becoming a professional. In the business world, you could think of it like an internship but after college. You have the knowledge, now you’re gaining the experience and skill. As one of my sources stated, “Residency is either a 3 or 4 year education in pediatrics. If they choose to do Medicine and Pediatrics, it’s a 4 year program. If they just do pediatrics it’s 3 years of residency. They take a maximum of 6 patients. Residents spend a month in our unit at a time, then move to see all the different areas of the hospital in their 3-4 years.” 

A resident’s supervisor is the Attending, which we’ll talk about shortly. Therefore, a resident’s role typically is to oversee a number of patients, direct patient care, do examinations, etc. For example, before rounds, the resident may come in the room to check on the patient and give the summary during rounds. The attending then gives the orders for what to proceed next. 

A resident is due exceptional respect. They have all of the knowledge, and now they are using their time to figure out a specialty – they may decide to go into one speciality because of you! How you treat them could greatly encourage them to continue helping others in a hospital setting or go into private practice. Respect them, learn from them, and realize their important role in your child’s care. You may be seeing them a lot!

A Fellow

If a resident decides not to go into private practice but further their study in the hospital world by choosing a specialty, they do a fellowship. For example, at Texas Children’s Hospital a fellow may choose to specialize in the ICU. They will be in the ICU for 3 years, lead rounds, perform most procedures, and they’re in charge of about 14 patients. They also are in the supervision of the attending(are you learning who the “big big boss” is??).

If you have a problem or question with a resident, the fellow may be the next to come in. See, the attending is an extremely busy person. Instead of bringing in the attending every time, hospitals are able to care for their patients better by delegating certain care to a fellow and resident, who are extremely valuable. This hierarchy is for our own good!!! Never forget that. 

The Attending 

While John and I were advocates (still are, but not in the ICU) when Paige was a baby, I remember John trying to explain these differences to me. There was one attending, a very tall lady who seemed to be exceptionally smart, and John would call her the “big big boss lady”. Don’t worry, this wasn’t offensive to her as she laughed several times when I teasingly called her that. You get the picture. She’s the one that had the most experience, expertise, and she made the big decisions. She was the boss. This does not mean the residents and fellows are not experienced, as I mentioned before! Paige simply needed the attending care more frequently because Paige did weird things. 

The attending came in to check on Paige about every day when she was there, plus during rounds. We never met an attending who was arrogant. They were humble, quiet, and when they spoke we all listened. At Texas Children’s, the communication is excellent. I never saw disrespect. Conversations were had, and patient care was always at the forefront. This is not the same everywhere you go. I completely understand that. We’ve seen both, unfortunately, and believe me my mama bear comes out when an attending does not respect a parents opinion. 

An attending can have very many specialties and typically sees just about everything. Again, they are worthy of our utmost respect. 

The Nurse

Nurses can be absolutely amazing – they have the job of being at the bedside. At Texas Children’s, it’s typically two beds per nurse and they have a window looking in at all times. They are your go between – they’re the ones by the bedside all day long, and they communicate their findings with the doctors. Nurses don’t get enough credit – that is all I’m going to say about that! 

Nurses do NOT make medical decisions except for certain things like if there are as needed meds in the chart. But if it’s not on the chart, they won’t do it. Nurses are limited unless it’s on the chart. However, they take care of so much – from listening, to helping change diapers, and to being sometimes the only friend you have during an ICU stay. 

Conclusion 

These are just four main roles in a hospital setting. You’ll meet more, like therapists, but these are the main ones in charge of diagnosing your child and taking care of the hourly needs. You are not alone – you have a team. Understand what they do so you can give them the respect they deserve.

In my next blog post, I’d like to talk about a very sensitive issue. One that a lot of us may think is the “elephant in the room”. If you’d like to guess what that sensitive issue is, let me know in the comments!