Patient Care Departments

Depending on their size, hospitals may have patient care units that mix patients with any type of condition on a single unit, or separate them into large categories such as surgical, medical, and mental health. Larger healthcare organizations usually have units that are further subdivided. They separate patients by organ (e.g., liver, kidney, heart), disease/condition (e.g., transplant, burn, cancer), or characteristics (e.g., acute, chronic, palliative, hospice). I’ve chosen to use a combination in the following example to explain as many unit types as possible. As such, you might not find all of this at a single facility.

Pulmonology and Cardiology (Heart and Lungs)

Some of the most frequently referred patients from outpatient clinics to hospitals have heart and lung problems. Conditions affecting the respiratory tract from the nose to the lungs, and all the pathways in between, plus the functions related to air exchange, fall under the specialty of Pulmonary Medicine, with Cardiac (Cardiology) a close second. What affects the lungs usually affects the heart and vice versa. The heart pumps blood into the lungs to pick up oxygen and, in turn, removes carbon dioxide waste products from the body. The lungs inhale oxygen, deliver it to the body via the blood vessels, and receive carbon dioxide and other gases expelled by the body’s organs into the blood for transport back to the lungs for exhalation. If the lungs and heart are not working in perfect sync, it impacts the rest of the body. If the transport system (veins and arteries) is impaired, a Surgeon may be called to perform Vascular Surgery to repair an area of the body where blood flow is blocked or severely restricted.

Pulmonologists treat conditions of the lungs, such as asthma, COPD (Chronic Obstructive Pulmonary Disease), cystic fibrosis, bronchitis, etc. Cardiologists treat the heart and circulatory system. They evaluate the work of the heart- how strong it beats, its rhythm, how well the chambers coordinate their beats, how well the heart is using oxygen, and other factors that tell how well the heart is pacing or pumping. If oxygen levels are low, the heart speeds up to get more oxygen and help it function better. When oxygen levels are high, it slows down so it doesn’t draw in as much.

Nephrology and Urology (Kidney and Urinary Tract)

The heart and lungs struggle when the kidneys fail to maintain fluid volume or remove waste effectively. If the kidney is not removing an adequate amount of fluid or filtering toxins from the blood, excess fluid begins to spill into tissues and other organs, and toxins begin to build up throughout the body. A Nephrologist (a doctor who specializes in diseases of the kidneys) evaluates urine output, blood flow to the kidneys, and the urinary tract system to determine where the issue may lie.

If the kidneys are not removing waste from the blood, the patient may need Kidney Dialysis, a mechanical process that removes waste from the blood through a shunt connected to a machine with a filtration system. The cleansed blood returns to the body via the shunt on the opposite side. Looking at the setup, you see a continuous loop of blood flowing in and out of the shunt, like a washing machine running through several cycles until everything is clean.

The other form of dialysis, Peritoneal Dialysis, is often performed at home. With this form of dialysis, fluids are inserted into the patient’s abdomen, allowed to remain for several hours, then removed. Large-molecule cells in the abdominal fluids remove waste products from the blood for disposal.

Another reason why the urine flow might be impaired in men can be an enlarged prostate. Often, urine flow is obstructed, and surgery is required to restore it. The department of Urology works closely with Nephrology to evaluate potential damage that can occur if this condition is ignored for a long time and back-pressure builds, damaging the kidneys. Such damage can lead to kidney failure.

Hepatology and Endocrinology (Liver and Endocrine/Hormones)

A yellow tint to the skin or the whites of the eyes can indicate a liver problem. Itchy skin is another sign of liver disease. Jaundice (yellowing of the skin) develops due to increased bilirubin in the blood. If you have these symptoms, see a Hepatologist to rule out conditions such as cirrhosis of the liver, hepatitis A, B, C, D, or E, liver failure, or other liver conditions.

Other medical conditions may present with similar symptoms, but they result from your body secreting too much or too little of certain hormones. For example, if you have increased thirst, hunger, itchy skin, frequent infections, vision changes, and make frequent trips to empty your bladder, you may have diabetes, a condition caused by the pancreas not secreting enough of the hormone insulin. Endocrinologists treat medical conditions caused by hormone imbalances (other than reproductive hormones). Endocrinologists treat disorders of all the following hormone-secreting glands and hormones. Any of these hormones may be secreted in too small or too large amounts, causing irregularity in the organ’s function.

Endocrinology

All these organs secrete hormones that regulate many of our body’s functions, and if their levels become too high or too low, the organs they affect do not function properly. The treatment for most of these conditions involves prescribing medications that help adjust the hormone secretion by the organs responsible for its production. The hospital Pharmacy or local outpatient Pharmacy helps patients understand their prescriptions. It’s very important for patients to know as much as they can about their medications, when and how to take them, possible side effects, and what foods or other medications might cause them not to work properly. If you have questions, a pharmacist is willing to help explain anything you do not understand. Medications can kill you if taken incorrectly.

Gastroenterology (Stomach and Intestines)

Gastroenterologists (GIs) diagnose medical ailments from the esophagus through the stomach and intestines, and out through the rectum. Therefore, if you are having difficulty swallowing, experiencing acid reflux, ulcers, Crohn’s disease, irritable bowel syndrome, constipation, diarrhea, or anything similar, these are the medical specialists for you. Be prepared for tests that involve drinking materials that will clean out your insides and specimen collections that involve putting things into your refrigerator that aren’t mentioned at the dinner table.

GI doctors treat digestive issues. After bringing food into your mouth, digestive enzymes begin the process of breaking down food for the body’s use. From the esophagus to the rectum, the GI tract nourishes all organs of the body and eliminates waste products after digestion. Working closely with this team are wound and ostomy care specialists. They teach patients and their families how to care for the skin around a stoma if the patient has a colostomy or ileostomy bag, or if the patient develops a serious bed sore. You may hear them referred to as Wound Care Specialists, Ostomy Nurses, or something similar. They can be of great help to you in healing a sore spot or preventing one.

Neurology (Nervous System, Nerves, Spinal Cord, and Brain)

Neurologists treat problems involving the central nervous system, including the brain and the nerve pathways that travel down the spinal cord and throughout the body. A neurologist evaluates conduction (nerve stimulation) and obstruction (a break or block in the nerve pathway) issues. Neurology has many specialized fields of study, including but not limited to stroke, brain injury, epilepsy, migraines, mobility conditions like multiple sclerosis and ALS, brain tumors, and much more.

Physical Medicine and Rehabilitation (PM&R)

With such a vast array of disorders, the types of therapies needed to address the scope of limitations and abilities are extensive. The department of Physical Medicine and Rehabilitation (PM&R) comprises multiple specialties that work together to develop individualized plans aimed at restoring the patient’s bodily functions to the closest approximation of the prior baseline. Therapists must have a “can-do” spirit to help the individual regain hope for a positive future and motivate them to move forward in their recovery rather than give up when the going gets tough.

Surgical Services

Plastic and Reconstructive Surgery (Plastic Surgery)

If an individual is involved in a car accident or has cancer requiring a significant amount of tissue removal, the person’s appearance afterward may be altered. Plastic Surgery has come a long way in restoring individuals to their prior appearance. Often, when individuals are involved in auto accidents, plastic surgery is not the only type of surgery needed.

Surgical Departments in large healthcare organizations are very large with multiple specialized subdivisions. Surgeons practice for hours, learning to avoid nerves, tie off blood vessels, and maneuver around nearby organs as they attempt to repair or remove unwanted obstacles in the human body. Working in tandem with the surgeon is the Anesthesiologist who ensures that the patient remains sedated and immobile throughout the operation. By maintaining the patient’s blood stability through adequate oxygenation, fluids, blood volume, and electrolyte balance, the Anesthesiologist significantly increases the patient’s chances of survival.

Oncology (Cancer)

To reduce the amount of Cancer patients must battle, a common treatment option in Oncology is using surgery to remove as much of the cancer as possible when it’s concentrated in one area. To prepare for surgery, tumors are initially reduced in size using Chemotherapy or Radiation Therapy (radioactive molecules) so that the surgeon has a better chance of removing the tumor and all cancer cells from among the surrounding cells. If the patient decides that the side effects of chemo or radiation therapy are not worth the trauma he’s experiencing and the surgery is not successful in removing all the cancer, the patient may elect to move into Hospice or Palliative Care. The focus of Palliative Care is pain management while still receiving treatment for the condition causing pain, whereas with Hospice, no life-prolonging medical treatments are provided; only comfort measures and pain management are provided.

Critical Care Areas

Access to laboratory reports and imaging is especially vital in healthcare settings where a patient’s medical condition may be unstable. Intensive Care Units, Burn Centers, Operating Suites, Poison Control Centers, Emergency Rooms, Delivery Rooms, Urgent Care Centers, or anywhere that individuals rush through the doors with loved ones in their arms who are bleeding, not breathing, choking, head crowning, knife protruding, or any state of emergency means those who job it is to help needs information fast. In a crisis, first responders immediately assess the airway, check breathing, stop bleeding, and evaluate the nature of the emergency, usually with lab work and imaging, in addition to taking a history and immediate physical assessment pertinent to the crisis. Each of these specialized care units has protocols to initiate a rapid response when a patient demonstrates a confirmed change in status. Depending on the size of the healthcare organization, the intensive care unit may be a single bed or an entire tower of specialized intensive care units dedicated to a variety of medical diagnoses. All are well-equipped to handle emergencies. The smaller units must be as well-trained as the larger ICU facility staff to handle multiple protocols, with fewer resources. Their dedication to keeping on top of the challenge is commendable.

Organ Transplant

While Transplant Services is not a Critical Care Service, per se, it might as well be. Individuals who receive organ donations must be carefully monitored both before and after their transplant to prevent rejection or infection. They often are in the hospital for months, near death, hoping for a donor organ, and then must return frequently after the transplant to ensure that no signs of rejection are beginning. It’s a scary time for them and their family.

Psychiatry

Not all hospitals have a Mental Health or Psychiatry Department, but some do. Some provide outpatient counseling with offices in the medical office building. Mental Health Counselors help patients cope with the emotional side of recovery, such as adjusting to changes in ability and the potential impact on employment or career choices. They also assist the patient and their family in discussing changes that may occur in their relationship or roles as a result of a medical condition or serious accident.

Some hospitals have psychiatric departments with extended-stay mental health patients. Depending on the types of patients admitted, these units may be open or closed units. If the hospital has an open unit, visitors must check in at the front desk, show what they have for the patient, and visit. If it’s a closed unit, visitors are limited in number and may be restricted to specific individuals, if allowed at all. Items allowed on the unit are very restricted due to the potential risk of patients using items to self-harm or harm others.