Physician Roles

Unsurprisingly, many physicians and nurses are required to care for a critically ill patient. For families, it can often be confusing to figure out the roles of all these people, especially when medical jargon is used. If you are unsure what a physician’s role is in your loved one’s care, please ask. Here is a quick guide to provider roles:

Primary physician/team: This is the physician or team of physicians who are overseeing all of the patient’s care. They are coordinating tests, medications, and calling specialists—called consultants—for particularly difficult problems. In a team, physicians in various levels of training may be participating.

Intern: This physician has completed medical school and is in the first year of their medical training (called “internship”).

Resident: This physician has completed medical school and their first year of medical training, and is now completing additional years of training (called “residency”).

Fellow: This physician has completed a residency (see above) and is receiving subspecialized training.

Attending: This physician has completed all training and is practicing independently.

Consultants: This is a subspecialist physician or team of physicians who have been asked to assist in a particular medical problem. A patient can have more than one consultant. For example, patients with kidney problems will often be seen by a nephrologist—a kidney doctor.

Procedures

Patients who are in the ICU often need invasive procedures performed. These procedures usually need permission from the patient or their family members, if the patient is unable to provide permission(“consent”). Providers should always wash their hands or use hand sanitizer before starting these procedures; some procedures may be performed “sterilely,” wearing a cap, gown, face mask, and gloves. Here is a list of the most common procedures performed in the ICU:

Central line placement: An intravenous (IV) catheter that is inserted under sterile conditions to give specific and concentrated medicines and fluids. This procedure is usually performed in the patient’s room, with the IV catheter placed in a large vein in the neck or groin. This IV is intended for short term use whenever possible.

Peripherally Inserted Central Catheter (PICC Line) placement: An IV catheter that is inserted into the patient’s arm under sterile conditions and is intended for long-term use. This procedure is usually performed in the patient’s room by a specially trained individual.

Arterial line placement: A IV catheter that is inserted into an artery under sterile conditions to help measure blood pressure more accurately. This procedure is usually performed in the patient’s room, with the catheter placed in an artery in the wrist or groin.

Intubation: A breathing tube (“endotracheal tube”) that is placed into the patient’s windpipe (“trachea”) through the mouth in order to assist breathing. This is connected to a breathing machine (“ventilator”).

Transfusion: Administration of red blood cells, platelets, or other blood products in order to correct low blood counts or manage bleeding.

Cardiopulmonary Resuscitation (CPR)

CPR is a series of procedures that are intended to try to restart the heart of someone whose heart has stopped (“cardiac arrest”). This includes putting in a breathing tube if one is not already present, performing chest compressions to try to circulate blood while the heart is not beating, giving medications to try to restart the heart, and, in specific situations, shocking the heart with electricity (“defibrillation”) to try to restart the heart.

Unlike what is often shown on television, CPR is not successful in most hospitalized patients. Only about 15% of patients who have cardiac arrest while in the hospital survive to be discharged from the hospital, and a very small number of these patients are able to return home. Some patients may have brain injury due to the brain not receiving enough oxygen while the heart is not beating. It is also important to remember that CPR does not fix any of the medical problems that caused the patient’s heart to stop. Patients are always sicker after undergoing CPR than they were before.

Most importantly, a choice not to have CPR will not affect your current care or result in your doctors stopping life-sustaining treatments that you are already receiving. A patient can continue to receive life support even if they decline CPR. If you choose not to have CPR, in the event your heart was to stop beating, your medical team would allow you to die naturally, without interference.