Staff-Family Conference Can Ease Stress of Hospital Stay

The hospital can be a confusing and stressful environment. These days a great deal of care can be safely provided in other locations, so often it's only the sickest people - those requiring the most intense levels of care - who end up in the hospital. This usually means that there are many people involved in the provision of care, possibly including several physicians, specialized nurses, social workers and other key staff. In addition, some doctors rely on a new kind of physician called a "hospitalist" to coordinate care in the hospital.

On top of the anxieties associated with being in the hospital as a patient or visiting someone you love, the support of family and friends can be difficult to coordinate. Many families are widely dispersed and most of us have little experience working together during a medical crisis, when emotional bonds can be severely tested. In all the confusion the threads of continuity with your family physician can sometimes be broken.

Communication under these circumstances can be sporadic. The written medical record may be the only source of common information and direction about the care plan. Yet as an illness intensifies, the written record becomes a less sensitive tool to provide clear direction, especially if conflicts or confusion are beginning to occur. These are the circumstances under which decisions must be made that can have life and death implications.

When complex circumstances are present, often a physician, nurse, or social worker will suggest that a family conference be scheduled. Ideally, this will involve at least one physician who is familiar with the current care plan, key nursing personnel, a social worker and, where appropriate, clergy. From the family, the patient should participate if healthy enough to do so, along with a selection of key family members, one of whom should be designated as the spokesperson. This is best the person with the power of attorney for health care.

After introductions, one physician usually reviews all the clinically significant information. Then the key decision points will be defined, along with some of the implications of each. There should be frequent pauses for questions all along the way. This is the time to get as much important information on the table as possible, to ask questions, and to discuss any past miscommunications or sources of anger or frustration. Usually as this process moves forward, a plan will begin to crystallize. It is then the responsibility of the physician/facilitator to restate all the key issues and to insure that everyone has a clear understanding as what the next steps will be.

The family conference requires an investment of time and energy on the part of all the participants, but it is time well spent. Important medical decisions must be made with deliberate clarity such that in retrospect, there is a sense of mutual confidence in the choices decided upon. The benefits of open, straightforward communication among all involved are significant to the patient and his or her loved ones. In addition, there is the peace of mind that comes with knowing that regardless of the outcome, all of those involved - family and medical staff - put forth their best efforts on behalf of a loved family member.

For more information on this topic, see the HealthLink articles Patients Can Help Promote Hospital Communication and Advance Planning is Crucial in Health Care Emergencies.

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