My eyes opened wide as my alarm blared, reminding me that it was time to get to the hospital.
As a third-year medical student rotating through internal medicine, it was my responsibility to be in the hospital early, check the patient list and pre-round on my patients before rounds with the attending physician. Rounds were often fast-paced to make time for the residents to complete the plethora of paperwork and electronic medical charting which filled their days. While every order was closely scrutinized to assess the risks and benefits, discussions with patients sometimes felt like they lasted mere seconds.
I pushed these thoughts aside and prepared for the day which continued as expected. I reviewed my patients’ charts and visited them in the morning. During rounds, I was able to share information about my patients concisely with the team outside each patient’s room. We then spent two to three minutes inside a patient’s room before moving on to the next.
As we approached our last patient on the list, a young nurse came up to my attending. She asked our team if we had heard about what happened last night. We were all puzzled by her question; based on our records there were no unusual events overnight. She explained that our 82-year-old male patient who was recovering from a stroke was accidentally given twice the appropriate dose of heparin for his body weight. A geriatric patient given double the dose of heparin is associated with a greater than 10% risk for hemorrhage and subsequent death. Yet the patient’s family was not yet informed about the mistake nor these risks.
In the room, we saw that the patient’s neurological exam was thankfully unchanged and that he was overall unaffected by the elevated dose. My team took full responsibility as we informed the patient’s family about the potentially fatal mistake. We spent more time in this room than any other room this morning as we discussed the “near miss” in a clear and evidence-based manner. Given the patient’s otherwise uneventful night, we ended the conversation by discussing plans for discharge later today. The family expressed that they understood the potential severity of the mistake; however, they still seemed to be confused. It was as if they had more questions, but could not find the words to explain themselves. I left the room feeling unsatisfied and wondered what I could do as a medical student to help them.
In mid-afternoon, my hospitalist team needed to drop off discharge paperwork for our 82-year-old stroke patient. Although this patient was not one of my assigned patients, I quickly agreed to do the task as I wanted to do more for this family. In the patient’s room, I talked to the wife and son about the mistake again and explained that there were no adverse effects as a result. Once again I felt that my words did not satisfy them, so I asked them what their concerns were.
The family explained to me that hospice frightened them more than the medical error. It seemed that multiple hospital personnel had used this term during their stay with minimal clarification. The patient’s wife went on to explain that she was not ready to stop treating his chronic illnesses and let him die. I used this as an opportunity to explain what hospice means: it is not the cessation of medical care, but rather a different kind of care with an emphasis on promoting comfort and quality of life. This was also not a decision that had to be made before they left the hospital. As I spoke, I could see the fear and confusion in their faces transform into understanding and appreciation. Although the conversation only took a moment, I could tell that taking this time made a difference in the family’s emotional state.
In the extremely efficient and fast-paced environment of health care, the emotional needs of patients and their families may become secondary to their medical treatment plan. But emotional stressors can also be directly associated with poor outcomes in regards to the healing process and overall quality of life. Thus, these needs should be addressed by face-to-face communication that allows for better patient education. Such investment of time is most rewarding when both the patient and family members have the opportunity to explain their fears and worries regarding treatment.
Transparent communication allows physicians and patients to share and address concerns. We can scrutinize the best evidence-based treatment for a given patient, but it may be futile unless we take the time to ensure that the patient understands and is satisfied with the plan at hand. Moving forward, let us advocate for communication and transparency to further enhance patient care.