As I continue to try and manage the care of my father after the catastrophic failure to rescue him, I remain amazed at the problems of communication related to his ongoing care.
Teams in hospitals today seem to change every week. If you then factor in asking someone to cover a weekend here and there, or an illness, you may have Attending physicians changing over perhaps every 5-7 days. That is the new normal for my father and apparently inpatient healthcare in general. There is no one who knows his recent horrible history except me (and my immediate family). As I talk to other physicians and nurses who have had ill family members, this seems the norm rather than an exception. Many of those healthcare providers feel that if they where not there, fighting for their family members, they wonder what might have happened!!
For further context, this means that I get to be the person who reminds each transition team that my father is here, in the ICU, being tormented because of a medical error. I get to try and remind physicans that the book my father was reading before his medical error happened was so dense and complicated that most physicians would not bother with it. He was not a demented old man. He was an 83 year old man who had well controlled medical conditions who is now in the ICU because of a “failure to rescue” and a resultant cardiac arrest, no small part of which was related to a failure to communicate.
Now, with multiple transitions of Attending physicians we continue to see the problems of communication. Someone comes and says he has a procedure that is to be done and we say, “no he does not”….”This is not what we agreed to.” We talk about getting a procedure done in the morning and I say, “he can’t do a procedure in the morning,” he won’t be able to participate because his medications will leave him confused and addled in the morning. Or…he is in Afib with RVR (you medical folk know what this is) and no one comes to help even though my dad now has an EF of 15% after his cardiac arrest and we can’t let him remain at this rate for hours!!
I tell you this because when I speak with the team caring for my father and I try to tell them about the difference of “communication versus simple medical care”, they seem to be baffled. What I mean by this is that they seem to believe that successful care is based on the diagnosis and the treatment. They seem separated from they idea that communication within teams and within other groups outside of the immediate team are not what is most important. They seem to think it is only about a medication and a diagnosis.
I am asking all of you, to stop thinking this way. Making the diagnosis is important. Treating that diagnosis is important. But it is not enough. We are trained to think it is enough but it is not. The requirement that we communicate is not only necessary it must be a requirement. Your medical knowledge alone will NOT be enough. You must be able to manage high risk clinical communication to all of the people in the team. You must demand it and you must require it of your teams.
If this is news to you….If you do not understand this, ask for help, find a mentor in Quality and Safety. Do it now. Before you harm another person in your care.