When doctor meets patient's family in the ICU: telling them what has happened and what's next

It's a daily occurrence in any hospital. Someone has been notified that a family member has been admitted to the ICU, but the details are sketchy, just that it's "something serious."

The person rushes to the hospital, parks in the garage, frantically rushes into the building, and on to the ICU, where he identifies himself, and desperately asks to know what has happened.

The nurse tries to calm him down, seats him, and insists that someone will speak with him shortly.

After a few minutes, which seems like hours to the person, a white-coated individual appears, introduces himself as the attending physician for the family member, and proceeds to explain to the person what has happened and what's now being done for the person's family member.

An enormously stressful situation for anyone to be in, for sure.

But is there a good, proven strategy for that attending ICU physician to follow when addressing the person at this point, preferred words to use or topics to cover, that will lessen the stress, while still reporting the situation?

Shouldn't an ICU physician already be prepared to handle this situation with a set procedure, even a kind of script, for this situation which will surely arise in the ICU, and probably often?

Even a brief survey of the web turns up a good number of articles on various ICU protocols, including how to handle that initial contact between ICU doctor and patient family member(s). So that a kind of checklist can be formed from reading those articles, to cover the main points for discussion that will likely take place between doctor and family in that stressful situation.

Such as:

QUESTIONS THE DOCTOR SHOULD ANTICIPATE FROM THE FAMILY AND ALREADY BE PREPARED TO ANSWER:

Why was my loved one brought to the ICU?
What has happened since then?
What are his or her main medical problems now?
What treatments are being given or planned?
What do the doctors expect to happen?
Who is the doctor in charge of my loved one?

OTHER ELEMENTS OF THAT INITIAL MEETING BETWEEN PHYSICIAN AND FAMILY MEMBER(S) THAT NEED TO BE CONSIDERED:

The doctor needs to report with a calm voice, with an in-control manner

He needs to sense from talking to the family member(s) how to proceed, how much detail about the situation he needs to give them, or that they can handle

if more than one family member is present, he may need to speak to some in a different manner than others

SITUATIONS THE DOCTOR SHOULD HAVE A PLAN FOR DEALING WITH:

What if the outcome for the patient is likely terminal? Discuss only if family asks? (And then be completely honest)

if not terminal, what if the patient's situation is grave (such as brain dead, or has suffered severe bodily injury)? Make judgment as to how much detail to include?

How to address desperate pleading from family member(s) to "do something!"

Research shows that sadness, fear and anger, in that order, are the primary emotions that people display in ICU conversations with physicians. Be prepared to deal with each.

What to do if a family member, upon hearing the dire situation of the loved one in the ICU, becomes hysterical or severely angry? Attempt to calm? Warn that security may have to be summoned, if civility is not maintained?

What to do if during the physician's conversation with the family members, a serious disagreement between family members breaks out, perhaps an accusation of blame for how the patient wound up in the ICU? (A way for the physician to handle it might be to point out that their loud disagreement "will bother others" in the area).

Just a few of a number of possible situations that might arise during an initial contact between the ICU physician and the patient's family members.

One website likened the physician's interaction with family members in the ICU to a law enforcement officer at a traffic accident. He needs to take control of the situation, maintain order, and do what he can to facilitate a smooth process for handling the situation.

Overall point: ICU staff should have a plan already in place for dealing with the above possibilities. Such plans will never cover all possible interactions that will come up between physicians and family members, and physicians will need to be able to think on their feet in particular cases.

But having a plan ready to put into play when briefing a patient's family or loved ones is a good preemptive move.

On a related note - If your loved one is under the care of a Hospice Group... Talk to them about various issues.

When my mother passed in the wee hours they tried to call my sister and couldn't get through... So they sent the local POLICE to make the notification... The Hospice people didn't have my sister's new address so the wrong household was awoken.

When I didn't answer the phone cause I was asleep, they sent the local POLICE (different city) to notify me.

Normal business hours would have been fine with us....