Dr. Baudendistel also tries to accommodate family members’ schedules, setting up visits when working family members are able to come to the hospital or making sure to have daily telephone contact if it is not possible to synchronize in-person visits with them.
Most families, he has found, are then willing to listen and work with him. As familiarity with hospitalists increases, family concerns about a “stranger” caring for their loved one slowly diminish. “Patients and families generally accept the idea of seeing a new doctor in the hospital a little bit more easily each year that goes by,” he notes.
Another technique used at California Pacific Medical Center, Dr. Baudendistel adds, is to pair a hospitalist with the same patient if he or she is readmitted. “We really believe in the continuity of the relationship, so we try to preserve that as much as possible,” he says, “because the big obstacle for hospitalists is always handoffs.”
On the Same Page
Intrinsic to forming a relationship with the patient and family is to discuss their goals of care, says Hawgood. Shana Weber, DO, FAAP, a pediatric hospitalist at Alaska Native Medical Center in Anchorage, agrees.
“You need to be on the same page,” she says. “Without knowing what the parents are hoping to get from their child’s stay before discharge, you really cannot help them.”
For instance, says Dr. Weber, some parents may be surprised to learn that their child is going to be sent home with a feeding tube or other nursing care needs.
“It is important to find out what their agenda is and what yours is. Parents’ expectations can be very different from ours,” she explains. “Letting parents know you’re listening—whether or not you agree with what they’re saying—is half the battle. You need to verify their feelings, let them know you’re listening to them, and that you understand their concerns.”
Use Team Resources
Accessing the expertise of other providers may be necessary to complete discharge plans for complicated cases. Dr. Baudendistel recalls a 30-year-old woman with a progressive neurological condition who had previously been living in the community. Her condition had deteriorated to the extent that she would no longer be able to eat safely, and, thus, she would not be able to return home. The team brought in a speech therapist, physical therapist, social worker, and discharge planner to meet with the family and present options.
Hospitalists interviewed for this article agreed that clinical social workers bring a much-needed perspective to dealing with families. One recent case at UCSF Medical Center involved a woman in her late 50s whose cancer, after multiple treatments and treatment complications, had come back very aggressively. One of her daughters, a young woman in her 20s, “had developed a very deep religious faith that she could cure her mother through prayers and faith,” recalls Hawgood. “As her mother deteriorated, the daughter became more angry and hostile to the hospitalists.”
Hawgood approached the daughter and asked if she would sit down and talk with her, and tell her what had gone wrong in the past, and “how we could improve things in the future.” As she listened to the daughter, she realized how much the daughter loved her mother and how desperately frightened she was.
“If I could help you in one way, what would that be?” Hawgood asked the daughter.
After a silence, the daughter replied, “We need a refrigerator.”
It turned out that the family was financially unable to replace a broken refrigerator. To take her mother home, the daughter needed a way to refrigerate enteral feeding supplies. And Hawgood was able to secure a refrigerator for the family, and says that the incident underscored for her the importance of keeping an open mind.