“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”
“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”
“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”
These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.
To illustrate my point here is a short story. A friend of mine texted me about a year ago. I was aware that her mother had been in hospital but did not know the details. This was the text she sent me…
I decided to phone the hospital myself and managed to get through to the Consultant looking after her mother. He started to tell me the details but I stopped him and asked him to phone my friend – she was the one who needed to know. His response was “I’m in an MDT meeting and too busy. Tell her to call my secretary and I will meet up with her in a few days.” I was a tad persistent, gave him her mobile number and said “Please phone her today. 5 minutes, thats all it takes.” He was unhappy but said he would try. A little later I received the following text…
(Note my text was ‘Not Delivered’. Great communication!!)
And the next day….
So, a 5 minute conversation with the consultant completely changed that individuals ability to function at work and at home. 2 weeks of agitation, worry and poor sleep gone….in 5 minutes. So why hadn’t that conversation taken place much earlier? Why did the consultant feel the need for a ‘face to face’ meeting? I would agree these are always much more satisfactory for all concerned but they are sometimes difficult to organise and end up delaying the communication for days. All it took was a phone call.
It got me thinking about my own practice. Do I speak to relatives enough? Am I proactive in phoning families to update them on their loved ones progress? The answer to this was no, so I had to do something about it.
It may seem an overly simplistic approach but what we have done is introduce a ‘Ward Sticker’ (see below) which is effectively a checklist which we put in our patients case sheets at least once a week (sometimes less, sometimes more). Now this list covers many things of which ‘Family discussion’ is only one but it is a way of ensuring that, on a ward round, someone has asked the question “Has anyone spoken to the family?” If the answer is no then we can organise that it happens but what I often do is just pick up the phone and call them. Unless it’s really bad news I don’t see any problem with a phone chat and, often, the information I get from them is extremely useful and changes management plans.
Do I get it right all the time? Again, no. It was only a couple of weeks ago that my colleague reviewed a patient in our Medical High Dependency Unit who I had seen several times over the preceding few days. She was young and very sick and, he informed me very politely, no one had spoken to her daughter since admission. I was mortified but then we don’t use the sticker on MHDU. Am I becoming reliant upon it? Must do better!
There is no doubt our patients are getting older, more complex and are increasingly muddled, especially on admission. Making a clear and definite diagnosis takes longer and often feels less than satisfactory – ‘Probable UTI’ or ‘Probable Stroke’ – and its in these scenarios that early family input can make a massive difference. You can feel like you are working in the dark but when you pick up the phone and speak to someone who knows the patient well, and really cares for them, then it can become clearer and, I think more importantly, you can allay that loved ones fears about what you are thinking of doing in the way of tests and treatments.
So if there was one thing I could ask it would be this – think about the family and loved ones early on in admission (preferably the first day) and use your phone a little more. A quick phone call can make a big difference and will often calm their anxieties, make your life easier and, perhaps, reduce the number of complaints coming through the system.
Ken Donaldson is a Consultant Nephrologist and Associate Medical Director at NHS Dumfries and Galloway