Hospitalist: how to handle pt family req to see hospitalist

[meerkat111]

Hi,
I am a newly minted hospitalist and I work w/o residents or med students. Some others in my hospitals do have residents who round for them. It seems patients' families usually come in at a comfortable time (for them, 10-2) and start asking to see the doc. Problem is- they all want to see me at the same time. I try to accommodate some and tell the rest I will call them later in the day. (of course, we all know families that want to see the doc multiple times a day) It takes most part of the day for me to round on all my pts and do admits (we currently do not have a swing shift). It seems some patients are used to someone like a resident checking on them in the AM...

Any suggestions on how to handle these requests will be greatly appreciated. Hospitals advertise that the hospitalists are always available and patients' families assume hospitalists are available round the clock to talk to them when in fact, this is really not possible with a schedule that is already way too long on a daily basis. We are of course available for medical needs and emergencies but seeing the families whenever they come in and multiple times seems unreasonable.

Thanks much!

---

Members don't see this ad.

 

[DrSnips]

If you are hearing through the RN that the family wants to speak to you, just relay back to the family through the RN that you are busy and will be available later. For particularly needy families, you may want to set some expectations about daily updates.

 

[gutonc]

If you hear "Mr. Jones's family wants to talk to you, say, "I will be available from 2:30-3pm to meet with them. Any family members who wish to discuss his case are welcome to meet me at the bedside."

Your time is valuable. Treat the nurses as your ambassadors, not your servants. Life will be much better for you.

 

[jdh71]

I tend to allow families to tell me what time they'd like to meet (with certain exceptions to my own schedule) and I do my best to accommodate them. I limit the visit to 15 minutes. I make it clear, if it's been an "issue," I see each patient once per day unless I think there is something that necessitates an additional visit or there is an emergency. I tell them I have many patients and many families to see and I won't be able to schedule a family meeting everyday. I tell them the times I'm usually rounding and I am happy to speak to whoever is present when I come along per usual on a daily basis. I communicate as much of this as possible to the family through the nurse. I believe part of my responsibility to my patient is also to keep their interested loved ones "in the loop," but this can't be at the detriment to the time I need to spend on care planning and coordinating for that patient and the rest I'm taking care of so I set boundaries. You rarely find someone who can't deal with the boundaries.

 

[visari]

I also try to accommodate family requests to meet as much as possible. Especially with genuinely sick patients where things are changing on a daily basis. For me that's usually the leukemia/BMT patients. Most families are reasonable and they understand that you're not available all the time.

on the other hand, if three different family members come at different times everyday to ask me why 88 y/o grandpa with metastatic prostate cancer and 4-5 other comorbidities is not getting over his pneumonia, I will set rules to meet everybody once daily at the bedside for 10-15 minutes.

 

[flipmd]

I usually preempt these kinds of requests to meet. If the family is not at bedside when I see the patient, I call the family after right after seeing the patient (after I ask the patient if he would like me to update anyone of course -- in my experience only about 1/4 of patients take me up on the offer and the rest say they will update their family themselves). I leave a message if they do not pick up. This way I have already talked to them, and if they have a specific question later in the day they don't usually mind if I just call the room for the specific question (of course, make sure to ask the nurse what the question is first, 50% of the time it is a nursing or case management question and not a medical one). Now if it's a complex patient in need of a real face-to-face interaction with family (especially goals of care), then I tell them to have the nurse call me when they arrive, but I warn them that I cannot promise I will be there within a few minutes, but at least I would know they are there and I would stop by within 1-2 hours. YMMV, as our patient population is such that family is actually surprised when doctors call them daily, as they feel we are too busy for things like that.