Who’s who in healthcare: your guide to your hospital stay

Being a patient in the hospital is tough when you’re not sick. Try navigating the hospital when you are sick.

Frequently, I’m asked to clarify who’s who in the academic hospital. So say you are admitted as a patient to an academic hospital, and you haven’t picked up the lingo from TV shows like Grey’s Anatomy, House or Scrubs.

You might be faced with the following caretakers (especially in an academic hospital):

Attending physician (the “attending”) – the leader of the team or consulting service who oversees training physicians.
Fellow – a physician who has finished residency and is pursuing further specialized training.
Resident physician (the “resident”) – a physician who is in training to gain expertise, usually in a specific field where they will be able to become board certified. This individual may oversee interns.
Intern physician (the “intern”) – a 1st-year physician in training who graduated from medical school the previous year. This may be the physician who you have the most contact with.
Medical student (the “student doctor”) – This individual is still in medical school and is not a physician yet.
Sub-intern medical student (the “sub-I”) – This is a medical student in his/her latter years of training and who is given more responsibility for your care than other medical students.
Physicians assistant (“PA”) – Physician assistants have attended post-graduate PA school and can function as physician extenders.
Nurse practitioner (“NP”) – Nurse practitioners can function as physician extenders as well.
Nurse – Of all the above members of your team, you will likely have the most contact with your nurse. Your nurse may monitor daily progress, your vital signs, administer medications and help you communicate with your team.

Other common term(s):
House officers – These refer to residents and interns.

Your team may be split up as the following:

The primary team – Your primary team serves as the point persons for your medical care.
Consulting teams/services/physicians – These individuals offer specialized knowledge in their area of expertise. They are often specialists (e.g. dermatology, oncology, infectious disease, rheumatology, gastroenterology…)

Bottom line, though, is that should you have any question about who someone is, ask!

The kidney and your skin

Image from wikipedia user Sanjayach

The skin has been described as a window into internal disease. You can’t see your internal organs with your naked eye but the skin is available for examination.

The skin can reflect disease in virtually every organ system of your body. Kidney disease can be reflected on the skin in many ways. Here are some of the presentations of kidney disease on the skin:

1. Itch (pruritus) – Individuals with chronic kidney failure often experience itching. The itching can be quite difficult to treat and can affect all the skin. I’ve had patients tell me that it feels like the itch is coming from “deep within.” The itch can lead to scratching which leads to further itching, etc. (the itch-scratch cycle)

2. Dry skin (xerosis) – The skin can become dry and scaly and lead to itch in and of itself. Liberal use of moisturizers can help.

3. Dark, yellowing or pale skin – Kidney disease can be associated with darkening (hyperpigmentation) of the skin, yellowing of the skin (thought to be from carotenoids), or pale skin from low blood counts.

4. Nail changes – Lindsay’s half and half nails are described in patients with renal failure — the far half of the nail is pink or reddish while the half of the nail closer to the cuticle is white.

Other conditions such as calciphylaxis, perforating diseases (“perforating disorder of renal disease”) or calcinosis cutis are also related to kidney disease.

Ingenol mebutate: a new treatment for actinic keratoses

Actinic keratoses (AKs) are growths that occur commonly in the sun-exposed areas such as the face, scalp, ears, hands, arms and legs. Just by themselves, they are not harmful, however they are considered pre-cancers. A fraction of these actinic keratoses turn into a type of skin cancer called the squamous cell carcinoma (SCC).

Most commonly, these spots are treated with a liquid nitrogen cold spray (cryotherapy). Other treatments include medicated creams like Aldara (imiquimod), Efudex or Carac (5-fluorouracil, 5-FU) are also used. Now, there’s a new player on the market: ingenol mebutate.

Ingenol mebutate is a gel and a recent study reported on its successful use in the treatment of actinic keratoeses in the New England Journal of Medicine. The researchers applied this gel for 3 days in a row for actinic keratoses of the scalp or face, and 2 days in a row for those on the trunk, arms, legs, hands or feet. Overall, there was good effect on these actinic keratoses — 42% clearance for scalp or face spots; 34% for trunk or extremities spots at 2 months out.

So is ingenol mebutate right for you? Well, there are several different treatments for actinic keratoses. Discuss with your doctor the benefits or risks of each treatment. For ingenol mebutate, keep in mind that is it a brand-name drug and may not be covered by your insurance as such.

What’s the right way to use moisturizer?

Image from wikipedia user Serenity.

For those of us who suffer from dry skin, there’s always that feeling of playing catch-up. How can you stay ahead of hand washing, chores that abuse the skin, dry air, and instead prevent that fragile, dry, cracked skin?

Proper use of moisturizers is a key component of successful dry skin care.

Find a moisturizer that is fragrance-free and hypoallergenic. A thicker moisturizing cream will be more effective than a watery lotion at sealing in moisture.

Moisturize immediately after washing your hands or chores involving water. Otherwise, the evaporation of that water on your skin can lad to more dryness.

If you’re at home or sleeping, you can wear a glove over your moisturized hands as well.

Rubbery bump on the head? It could be a cyst.

Do you have a rubbery firm bump on your head? It could be a cyst. Cysts are often found on the scalp of the head — they can present as firm, rubbery bumps or nodules. Over time, they can grow in size. They sometimes become red, inflamed or irritated. They can get infected (in which case, it probably will be red and inflamed). If punctured or ruptured, the cyst can release its contents — sometimes, a stinky thick white cottage cheese-like material can come out.

So what should you do if you suspect you have a nodule on the scalp?

Well, you should probably get it checked out. Most cysts are normal, but you don’t want to be wrong and miss something like a tumor!

If your doctor determines that it is a benign (non-dangerous) cyst, then this could be cut out if you want. This procedure is done in the office, is relatively fast, and just requires local anesthesia (like lidocaine). If your cyst is irritated, you may have to wait until it’s not irritated before it is cut out.