Getting The Information You Need

When a loved one is in the hospital, it can difficult to find out exactly what the plan of treatment will be. But, as our expert points out, there are ways to get the information you need.

A reader writes:

“My mother has lung disease and other conditions that have her in and out of the hospital. I’m trying to keep tabs on her treatment, but she’s seeing several different doctors and they come and go on a random, rotating basis. One doesn’t always seem to know what the others are planning. Is there any way to get more continuity of doctors and treatment, or at least to make sure all of her doctors are on the same page?”

Ken Faulkner, an expert in clinical ethics and a faculty member in the Department of Patient Counseling at Virginia Commonwealth University, responds:

“You’re describing a pattern of difficulties that often occur in large hospitals when a number of individuals are involved in the treatment process. This confusing scenario is especially true of academic medical centers that employ a large number of specialists who regularly rotate patient care responsibilities. The upside to having so many experts available, of course, is the thorough investigation and diagnosis of the patient’s condition. The downside may be, as you point out, that it is often difficult to know exactly who is in charge of the coordination and decision-making process.

“In spite of the confusion, however, there should be one doctor who is the primary ‘attending physician’ for your mother’s case. The attending physician is the one authorized to direct the total care of the patient. The attending may call upon numerous specialists to give advice and recommendations, but the attending is authorized to accept or reject these recommendations and implement them accordingly. Ask for a regular consultation with the attending in order to gain an understanding of what the complete ‘game plan’ is for your mother’s care. The attending should be able to explain your mother’s treatment, how the plan of care is evolving based on the recommendations of others, and what can be expected in the near future. If the attending physician shares rotating responsibilities with other colleagues, they too should be apprised of the details of the plan and be available for consultation. The point is, ask to speak to the attending for the comprehensive review and update you need.

“Other persons may be able to help as well. A health-care team often includes a nurse with advanced training who serves as a coordinator of care and information among all the specialists. Sometimes these individuals are nurse practitioners or clinical nurse specialists, or nurses with other types of credentials. These nurses can often be a welcome liaison and reliable source of information about what is happening on a day-to-day basis. They may also be able to communicate your concerns and questions to the attending physician and arrange a meeting.

“Another helpful person may be the primary care nurse, or the nurse responsible for the regular bedside care of the patient. He or she can help arrange a conference with some or all of the physicians involved, who can then update the family on the plan of care and agree together on future goals of treatment. These patient care conferences, held on a periodic basis, can be instrumental in keeping everyone on the same page. They can also reinforce the need for clear channels of communication.

“If no one else seems responsive to your requests for information and direction, then seek an advocate in the system. Such persons may be found among the nurse manager, social workers, chaplains, or persons designated by the hospital to serve as patient and family advocates. Every hospital should have someone who helps patients and families get what they need regarding information and the plan of care. Patients and families have a recognized, fundamental right to all information regarding care and treatment. The physician(s) and hospital have a legal and moral obligation to be responsive to these requests. Identifying the ‘quarterback’ of the care team may sometimes be difficult, but the patient and the family are understood to be the ‘captains,’ and you can get help by asking the right persons.”

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