6: Titles
It is valuable to ask doctors whom you see in hospitals for their names and positions. You will see from the following how experience and knowledge and authority vary and you will have some sense of whether there is a higher person whom you might ask to see if the situation is not satisfactory. It is in the nature of teaching hospitals that EVERYONE is learning, even the most experienced learn from new cases and about new treatment regimes.
You can expect to meet professionals at different levels.
MEDICAL STAFF
An INTERN..is someone who is in their first year out of university. Interns are rotated through different departments in the hospital, learning, only taking responsibility for the most basic tasks
a JUNIOR RESIDENT or SENIOR RESIDENT... the next two years of experience... in which the young doctor may seek increasingly to focus experience in particular areas of career interest. At the weekend a resident may have responsibilities right across the hospital.
a REGISTRAR... when the doctor, now at least three years out, acquires supervision responsibilities in the ward, in the operating theatre, in the outpatients clinic. Generally this is a doctor choosing a speciailsation but it is not necessarily a doctor yet undertaking the postgraduate training for that specialisation. They may be preparing for entry exams to a specialist college's training program or they may have begun the training, or they may not yet be at that point. They may still be rotating through different departments... so while a registrar will have broad supervisory responsibilities in a ward or department, and should have strong qualifications for that generally, this is not necessarily a person with full specialist knowledge.
a STAFF SPECIALIST or CONSULTANT... these are specialists who have undergone the exams and training programs for membership of a college (physicians, surgeons, etc, and these days also general practice). The consultant being, unlike the staff specialist, a person in private practice who is contracted to the hospital, or in a private hospital may see patients as private patients. These are the 'big fish' who come cruising the ward, often with lesser fish attached, of all grades of doctor and nurse, most often at the end of the day if they are surgeons, at other times as oncologists. Their time is often genuinely short. Prepare for the pressure of a quick discussion, have questions ready, but not so ready that you do not hear the information the doctor brings. Pen and paper are always useful to make sure you get the story right. If you don't have a clear recall, go later to speak to registrar or resident working in the ward, who was present during the specialist visit and get it clear.
There may also be, especially in Accident and Emergency departments, RMOs - Registered Medical Officers. These are people who are not permanent staff or in the intern/resident/registrar stream, generally working under registrar supervision and may have lots of experience in different fields.
NURSING STAFF
The ranks, from the most junior, are
Enrolled Nurse [EN] ... with less than graduate qualifications
Registered Nurse [RN] ... university graduate experience (some in specialist departments, like neurosurgery, of public hospitals, may be pursuing masters or PhD qualifications
Senior ranks:
Clinical Nurse Specialist [CNS]
Clinical Nurse Consultant [CNC] (highest rank) — at these levels you can expect huge experience and a very broad awareness of the specialist medical and care complexities of the ward or department.
Key figure: Nurse Unit Manager [NUM]
as in "I'll have to ask the
NUM". Be nice to the NUM.
Staff and contract nurses
There will often be contract nurses in wards, making up nurse-patient ratios but they are generally not in a position to know the key issues of the week in
the ward or the key issues confronting the patient.
Students: be conscious that in the public hospitals there are also
going to be student doctors and nurses. Be kind to all, help them
learn civility and openness, not power struggle and defensiveness.
ALLIED HEALTH:
There will be social workers, physiotherapists, occupational therapist and also speech therapists coming into wards, as needed.
The social worker will be concerned to see that a patient/carer/family may have the necessary resources to be OK after discharge. Issues of financial or emotional support should be raised with the social worker.
Where a patient is in hospital for some days after an operation a physiotherapist will come to assess fitness and organise exercise. But exercise is good, as soon as possible, don't wait for the physio, but check with the nursing staff first. You may require the clearance of the physio to go home.
An occupational therapist can advise on any technical aids or practical techniques for living with any deficits.
A speech therapist is appropriate not only if there is any speech problem but also if there is any interference with swallowing ability.
Some of these activities may be overseen by a doctor specialising in rehabilitation.