Last reviewed and revised February 27, 2013
If you have ever been a patient, you may have run across a number of people who were not your doctor but played some other role in the delivery of your health care. There is the person at the front desk who greets you at appointments, the person answering the phone when you call, the person who sees you when your own doctor is away, and various specialists whose exact title or role may be mysterious to you. Some call themselves doctors and even perform surgery and yet have never gone to medical school. Who are these people, and what exactly are their roles?
In a previous column I discussed the names and roles of physician specialists, medical doctors who focus their practice in one area of medicine such as lung disease or heart disease. In this column, we’ll cover some of the non-physician health care professionals or assistants whose roles may be confusing to you. After all, it’s not always enough to understand what your doctor is saying — it’s also important to know who is saying it. Read on to learn more about folks involved in your health care who may not have gone to medical school but whose roles may be vital to your health.
When you call your doctor, do you know who it is on the other end of the line? Once you get through to a human being, you are probably speaking with a member of the clerical staff. For appointments, leaving a message about refilling an existing prescription, a request for a referral to another doctor, or billing questions, you probably don't need to speak directly to your doctor. However, for a specific medical question, a new symptom, or a request for medical advice, the person on the phone will take your number and pass the message along to your doctor (or other health care professional with whom your doctor works), especially if it is urgent. (Of course, for serious or life-threatening emergencies, such as chest pain, trouble breathing, or bleeding, it's often best to proceed directly to the closest emergency room rather than calling your doctor).
Some front-desk staff become so familiar with certain patients or common problems, you might think he or she is a nurse or doctor; and some experienced clerical staff can be a big help to you by knowing when to interrupt your doctor with a message and knowing which questions or messages can wait.
Nights and weekends, your doctor’s calls may be forwarded to an answering service that takes the message and contacts your doctor, the doctor on call or another health professional, such as a nurse trained to "triage," that is, to decide which problems can be handled over the phone and which should be referred to the emergency room or other facility. In general, non-physicians practicing "telephone medicine" have guidelines about common problems that they follow carefully and they have physician backup if they encounter an issue that is more than they can handle. Increasingly, there are online options to contact your doctor's office with quesitons, scheduling requests or medicine refills. In most cases, they are handled much as a phone call would be.
After you arrive for your appointment (hopefully, without a long wait), you may meet a health assistant who checks your blood pressure, heart rate, temperature and weight, and he or she may perform an EKG and draw your blood if those tests are requested. Health assistants typically receive training to perform these specific supportive roles on the job or in a one- to two-year vocational program. In some offices the clerical staff and health assistants perform similar or overlapping roles.
The actual medical care is delivered in most offices by a doctor, a nurse practitioner or a physician assistant (P.A.). In the United States, nurses have graduated from nursing school or college and many accept positions at hospitals providing care to admitted patients alongside doctors. In order to practice independently — to see patients, gather relevant information, perform a physical examination, arrive at a diagnosis, and then recommend tests or treatments — additional training is required. Nurse practitioners, for example, concentrate on one area of medicine, such as obstetrics and gynecology or primary care, and are then licensed to see patients on their own (with physician backup). P.A.s perform a similar role to nurse practitioners but require fewer years of training, are trained in a broad range of medical areas, and provide medical care with a physician as one part of the overall care for a particular patient — that is, the M.D. and P.A. are teammates, and the physician is ultimately responsible for the care delivered. Nurse practitioners, on the other hand, are responsible for their own patients and refer patients to physicians who require specific medical care.
While physicians commonly specialize in one area of medicine (for example, cardiologists deal primarily with heart disease), non-M.D. specialists also may be a part of your health care team. Common examples include:
At least two other areas of medical care deserve mention when considering medical care by providers other than medical doctors (M.D.s).
When you are ill, it may be difficult to keep track of the names, faces and responsibilities of everyone involved in your care. The teams of doctors, nurses and other health care professionals in the doctors' office or hospital may seem impossible to keep straight. Everyone involved in your care should wear a nametag and introduce him or herself, but even then, their role may not be clear. If you are receiving care from someone whose name or job you don't know, make it your job to ask. Or ask your own doctor. But don't hesitate to find out — medical care is scary enough without being left in the dark.
Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.