Is Your Patient Being Harmed By Mixed Messages In The Hospital?

When you and your colleagues are rounding on the patient, each of you gives the patient/family an update on the patient’s condition. The pulmonary doctor will say, “Your lungs are doing better.” The cardiologist will say, “Your heart is failing.” And the internist will say, “Your infection is getting under control.” These are all true statements but the patient gets confused. Patients tend to focus on the good news you have given them and forget the bad. So when you come in later to talk about a DNR, they are shocked because patients don’t understand how the organ systems work together. This is one of the primary reasons people don’t want to sign a DNR. They don’t understand the big picture about their health. They don’t understand that your lungs can be better and you can still die because your heart is failing. And I am not even talking about the miscommunication that can occur because of language differences, medical illiteracy, language illiteracy, cultural differences and differing levels of capacity. All of these make things worse.

But you do have power when it comes to mixed messages. Make sure the attending is speaking to the patient or the family every day and giving them the big picture. The attending needs to explain how the overall view is for recovery. Some hospitals are creating a, “Captain of the ship” policy to mandate these big picture updates. This can become especially important when the patient shifts from being a surgical patient to a medical patient. It the captain of the ship needs to change, make sure the new captain now knows that they are in charge.

Nurses can do the same thing. Each day, different nurses are assigned to the patient. And each nurse gives a slightly different evaluation of the patient. Or they say, “You are doing better.” What does “better” mean? It doesn’t mean better and the patient is going home, it means that they are doing better than the worst moment they have had in the hospital. Lots of people die in hospitals that are doing “better.” Better doesn’t tell you the whole story. So, please be careful and give clear information. And you may have to give the information multiple times, especially if it is bad news. It takes much longer for bad news to sink in than good news. And it would for you too, if you were the patient.

Have a kind and respectful day.