From intern to consultant: How to know who's treating you in hospitals

A medical officer examining a patient. (Courtesy)

Whenever you patronize large health institutions, you will sometimes be unsure of who's who among the vast number and grades of doctors often available. This is especially so in teaching hospitals. You should always be aware of the cadre of your doctor, if only to keep your confidence levels heightened about the quality of your healthcare.

In teaching hospitals, you will often encounter medical students. But their presence is for the sake of learning. Medical students have limited responsibility for direct patient care. Your permission for their presence during consultations should always be sought.

After qualifying from medical school, doctors spend their initial years working under close supervision. They are often called interns, and rarely take independent care of patients. If an intern sees you, they usually discuss your care with a senior colleague. After internship, doctors become eligible for independent practice, and eventual additional training to become specialists.

Postgraduate trainee doctors are referred to as registrars or residents. They progressively acquire specialized skills and experience, and undergo competency assessments and examinations. Gradually, they become the 'front line' doctors dealing with emergencies and common problems, often in close liaison with consultants. On completion of training, residents transit into semi-independent specialized practice prior to being registered as consultants.

A consultant leads the care of patients under his/her team, and also takes responsibility for the training of junior doctors. Consultants usually have additional managerial and organizational roles. Even though consultants may delegate some chores to junior colleagues, they have ultimate responsibility for your care. You may not always be aware that key decisions seemingly made by junior doctors have often been discussed with, and authenticated by consultants.

Some consultants spend more time training in selected specialised areas, for example infertility of cancer surgery.

They are referred to as sub-specialists, meaning that they have additional expertise. They may still continue with a broader clinical practice, but some will only see patients with complex problems in their field of sub-specialization.

The tiered organization of healthcare means you can have confidence that your doctor is capable of taking good care of you. You reserve the liberty to ask what level of training your doctor has gone through.

Even though it's desirable to allow medical students and postgraduate doctors to be involved in your care, your consent for their involvement must always be sought.

If you expected to see a certain doctor and a different one shows up, you should always demand an explanation. Your consultations must always be led by an appropriately qualified clinician.

Dr Murage is a Consultant Gynecologist and Fertility Specialist. [e-mail]