Session 70

In today’s episode, Ryan and Allison talk about family meetings, in line with last week’s podcast about end-of-life care, and specifically how you’re going to communicate that during a family meeting and how to best set up family meetings.

During residency, Allison spent a ton of time on a project all about family meetings and end-of-life care. Ryan and Allison believe that giving this kind of education to you will be very helpful as you’re about to embark on your medical career.

Here are the highlights of the conversation with Ryan and Allison:

Allison’s internship:

• Day 3 of internship in the midst of taking care of different patients
• Inherited a very sick patient who recently came out of the ICU
• Getting overwhelmed by everything going on with her patient
• The family wanted to have a meeting
• Allison recognized she needed help in leading the meeting so she went to her junior resident to ask for help.

Tips to Running a Successful Family Meeting:

1. Always prepare.

Do your homework. Make sure you know which patient you’re talking about (name, where they are). Refresh yourself on what recently just happened with the person.

2. Get with everybody else that has been taking care of the patient.

Medicine is a team sport. Understand that it’s not all about you. There are nurses, social workers, other physicians, and other specialists that are taking care of this patient. So reach out to them and get information from them about the family.

*The patient’s nurse must always be a part of the family meeting.

They are spending a huge percentage of their day with that patient so they may know the family so much better than you do and understand the finer details.

3. Think about privacy.

Although a lot of hospitals now have a lot of dedicated family rooms set up, be careful not to have a big conversation or update with family members next to other people.

4. At the start of the meeting, inquire about their understanding of what’s going on with the patient.

One of the pitfalls people make when they go into a family meeting is they rush ahead and talk about what’s going on while the family doesn’t understand what’s going. Make sure you’re aware of what they know so far so they don’t get confused.

5. Avoid the medical jargon.

Don’t be throwing out medical jargon because the family won’t have an idea of what you’re talking about.

6. Goals of Care

This is an extremely crucial concept although it doesn’t necessarily have to enter into every family meeting. This is a meeting about addressing the goals of care. Listen to Session 69 and know more about this. Once you’ve clarified the family’s understanding, talk about the goals of care at this point.

7. Listen and answer questions.

Make sure to listen to the patient or the family member. Listen and pause to get a feel of what they’re thinking and feeling. Make sure the family is understanding what you’re saying. Repeat anything if necessary.

Guide the family on this journey.

You’re there to provide information to them and help them make a decision that will help them as to the next steps of their loved one’s care, be it comfort care or changing the goals of care or discussing a new treatment.

One last thing…

Understand the wishes and desires of the patient as far as DNR/DNI.

We all have living wills, regardless of age, because life is unpredictable. A few patients will come into the hospital already with a healthcare proxy or with advanced directives. So be aware of those things.

Some pieces of advice for those transitioning into internships:

• Medicine is no longer paternalistic. You have to come up with the best decision for the patient based on your knowledge, the family’s knowledge, and what’s best for the patient.
• Don’t offer unreasonable things which are not appropriate. Just because you can doesn’t mean you should.

Links and Other Resources:

Session 69: Palliative Care – There is Always Something You Can Provide

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