Cedars-Sinai Medical Center

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MEC rule defines the role of 'Attending Physician'

The word "attending" is used a lot around here. You can be an attending on the medical staff. You can be a member of the attending category of the medical staff. And now there’s a specifically defined “Attending Physician.”

The Medical Executive Committee has made some important changes defining the roles of the Admitting Physician and Attending Physician. This should clarify who made the decision to admit a patient and who is responsible for dealing with problems and with critical test results.

"Every patient needs an Attending Physician whose name will be listed on the CS-Link™ banner. If you are the Attending Physician for a patient, the laboratory and radiology departments will know that they can count on you to help if a test is ordered and the person who ordered the test isn't reachable," said Chief of Staff Scott Karlan, MD. "The medical staff expects the Attending Physician to accept those responsibilities. If you’re the attending physician and you’re not available, you need to make sure someone else is."

Medical centers such as Cedars-Sinai have large talent pools ranging from subspecialists to super subspecialists. An admitted patient will usually receive care from more than one physician. This team approach is great for patients, but it comes with some unintentional consequences, Karlan said. A long-standing problem happens when lab tests or X-rays are ordered and results come back with an urgent or critical value and the individual who ordered the test can't be located. The lab or radiology then typically call the nursing station to find a physician in charge, but the physician who admitted a patient on Monday might not be around on Wednesday.

Sometimes, it can take hours to locate someone to help – a problem for a patient who requires urgent attention.

The MEC recognizes that it's not reasonable to expect doctors to be on call all the time, but someone needs to "captain the ship," Karlan said.

  • If you're taking the night off and your partner is covering, you may not need to do anything. If you use an answering service and they connect your calls to the covering doctor, then that doctor will be able to handle any problems that arise.
  • If your answering service isn't very efficient, or if you're leaving town for a while, you should log in to CS-Link and change the name of the Attending Physician to the physician covering for the patient.
  • If you wish to transfer the patient to another doctor, you can assign them as Attending Physician, after getting their consent.

"There may be some bugs to fix, but right now, our concern is ensuring that it is clear to the nurses, the lab and radiology who is responsible for trouble-shooting problems," he said.

Physicians who do not want this responsibility have the option of making coverage arrangements with another physician or using a hospitalist. However, Karlan cautioned, the person designated as Attending Physician is not likely to get all that many phone calls.

"The bottom line is, the buck stops with you – if you're listed as the Attending Physician, you need to be available," he said.