Code blue: Hospital-patient communications

My dad was released from the hospital today after a month of ups and downs. During that time, my sisters and I spent plenty of moments at his bedside trying to keep track of which specialist was which and how the diagnosis and the plan were evolving daily, sometimes hourly. I thank God that he has come through a life-changing and harrowing experience. At the same time, I’m puzzled at how critical communications are delivered in a hospital environment.

Why do doctors speak to patients during 6 a.m. rounds? Patients are half-asleep, drugged and potentially hearing scary information for the first time. Of course, that’s when the doctors are available, but is it the optimal time for patients? Can patients be expected to make good decisions under the circumstances? They don’t have any family there at that time of day. Who helps people who have a language barrier or a cognitive impairment? Who makes sure they have understood properly?

Why don’t hospital patients receive any written information to refer to later or to discuss with family members? Every communicator knows that people need to receive information several times through different channels before the information can be fully understood and acted upon.

When companies announce layoffs, they do it face-to-face and provide a printed hand-out containing key information. It’s well established that when people receive difficult or shocking information, they don’t hear everything that follows. The brain is overwhelmed with emotion and rationality falls away.

A friend recently told me that when she and her mother accompanied her father to his cancer diagnosis, they left that meeting with three distinct perspectives. Her father was thinking “Shit, I have cancer.” Her mother was thinking “How do we manage this?” Finally, the daughter, who works in healthcare, was thinking about the diagnosis and the course of treatment. Cancer patients leave their meeting with a huge binder of information. Where’s the well thought-out, plain-language information and resources for hospital patients?

Don’t get me wrong. I understand that things change very quickly, often dramatically, in a hospital setting and that doctors can’t be bound by a document that could be stale as soon as they leave the room. I understand there may not be time to write everything out for every patient, especially where stays are very short. But surely there can be a solution that takes time, accuracy, resources and liability into consideration.

I have to say, my dad received excellent care and his doctors and nurses were very good about updating us when we asked. Not being there for 6 a.m. rounds, we relied on them to check the chart and to provide updates; but it all felt very discrete – hour by hour or day by day – as opposed to a holistic person and a holistic plan. My sisters and I exchanged the updates, at least our understanding of them, and pieced together different specialists’ feedback. Eventually, we requested a family conference with all the specializations in attendance. That helped immensely, but again, we initiated that meeting and we took our own notes.

Definitely, hospital resources are stretched, but Canada’s population is aging and more people have complex healthcare needs. Improving patient communications might help reduce the workload of doctors and nurses who have to answer questions frequently.

For example, people who are isolated for potential hospital-borne infection are currently told they are being tested and then moved to a new room. Why not provide a one-page handout that explains what is suspected, what is happening and the expected treatment? What about a short video? It would help families and visitors understand what’s happening without bothering the nurses.

There is a massive range of standard questions that could be proactively answered in written or video format from how to switch tv and phone if you’re changing rooms to the importance of handwashing and of minimizing exposure to more serious issues like things to consider for palliative care. These could be fact sheets at the nurses’ desk or on-demand video you can access from any device. Wherever possible, the information could be standardized across hospitals for even greater efficiency.

I am definitely not asking doctors or nurses to do more. I am suggesting that we consider the most vulnerable audiences and challenge the communications status quo in hospitals, especially for very complex cases.