One of the questions to ask if you or friends or relatives are hospitalized is, “Who’s the attending?” Attending is short for “attending physician.” The attending physician is the doctor who is primarily responsible for the patient during the hospital stay. Often, the attending is a hospitalist (a doctor who sees only hospitalized patients).
However, it sometimes seems as if no one is in charge. When a relative was unexpectedly hospitalized recently on the east coast, I spoke with a nurse in the emergency room.
“Who’s her attending?” I asked.
The nurse said, “She’s still in the emergency room. They won’t assign an attending until she’s admitted.”
The first doctor who called me was an orthopedic surgeon.
I asked, “Are you her attending?”
“Yes,” he said, “I’m her surgical attending.”
“Is there another attending? A hospitalist, maybe?”
“Yes.”
“So what’s the name of the hospitalist?”
“I really couldn’t say,” the surgeon admitted.
Thus, it did not seem that the two were in contact about the patient’s care.
When I met the hospitalist the day after surgery, I asked what his role was.
“I’m the medical attending,” he said, “and the surgeon is the surgical attending. But you won’t see me again. And you won’t see the hospitalist from yesterday, either. He was the admitting hospitalist; he doesn’t see patients after they’re admitted. And our schedules run Friday to Friday, so tomorrow I’ll be assigned a new group of patients. So she’ll have a different hospitalist tomorrow.”
Thus, my relative had three different hospitalists in three days. On the surgical side, the surgeon who operated saw her on only one of those days. On the other two days, two different people from his practice came to check on her, one each day.
So who was really in charge, overseeing my relative’s case to ensure the best possible outcomes? No one, it turns out.
I asked one of the hospitalists who would decide when my mother would be discharged – him or the surgeon?
“We both decide,” he said.
“What criteria have to be met for her to be discharged?”
“Well, that depends.”
“Okay, in her case, what criteria have to be met?”
“It’s hard to say.”
With no one in charge and no clarity about goals to be met before discharge, it’s no surprise that my relative was subjected to medical errors that slowed her recovery, resulting from uncoordinated activities.
What can you do? Keep asking, “Who’s in charge?” Fuzzy answers alert you to the need to be even more diligent in watching for mistakes and uncoordinated care. Pay particular attention to ensure that the drugs officially ordered are the ones you have learned that the patient is supposed to get – no more, no less.
