practice partner
In fact, Dr. Overgaard says what family members respond to is the very directness of the information. “They
see we’re not hiding anything from them.”
Dr. O’Brien agrees that blunt talk doesn’t increase
worry for families; to the contrary. “Parents say it decreases their anxiety, because they see the thoughtfulness
and begin to understand how we make decisions. We let
them in behind the screen.”
The Mount Sinai NICU long had an open door policy
for families to be present at rounds. The difference? “Now
we actually want them to be there and they have an active
role to play,” says Dr. O’Brien.
Before, the team would ask parents at the end of
rounds if they had questions or concerns. “Often, they
would just say no, because they were intimidated or
didn’t want to interfere,” says Dr. O’Brien. “Now we ask
parents to start the rounds. They tell me they feel a lot
more involved.”
Having family members aboard hasn’t slowed the
rounds, another concern. “The point of the exercise isn’t
to change how we do things,” says Dr. Overgaard. The
team wants families to get the gist of the situation, and
can always fill in more details later.
If anything, “The rounds can be faster by having parents there,” says Dr. O’Brien. “There are huge efficiencies
from having parents who know the baby and who are
the continuous caregiver. They have the background that
team members may not have. The parent at the bedside is
often the first to notice subtle changes in the baby.”
During the rounds the information flow is two-way,
44
Dialogue Issue 2, 2015
Communication is care
Dr. O’Brien, who has trained nine centres in Canada on
FIC, says the approach used in family rounds should remind all doctors of some communication fundamentals.
Look people in the eye. Acknowledge them. Don’t bypass
the patient by focusing just on the problem.
She says that sort of communication doesn’t just support care; it is care. “It’s from building relationships that
we can make decisions that work,” says Dr. O’Brien. She
says one doctor who participated in the FIC model “felt
his care became more human, more rounded.”
For Dr. Overgaard, the family rounds show how
transparency breeds trust. Even when you have to
discuss the elephant in the room, you can do so in a
way that’s humane. The rounds experience is a reminder
that clear and direct communication – at all times and
perhaps especially when someone is critically ill – is at
the core of care.
“In general, we can underestimate the lay person’s
capacity to understand and assimilate what’s happening,” he says. “The more open and honest you are, the
better.”
photo: D.W. Dorken
Dr. Karel O’Brien, a staff neonatologist at Mount Sinai
with the team often gleaning vital insight from
family. Dr. Overgaard mentions one heart attack
patient. Normally, they would take her to the cath
lab to unblock the artery, but she had many comorbidities. On rounds, her son described how she
had longstanding edema with no defined source.
“We had a group discussion, and that family
member participated in a way that changed the
care direction,” says Dr. Overgaard. “Rather than
go to the cath lab we opted for a non-invasive initial approach. That was partly related to the stories
the son told us.”
Having family on rounds can also promote better care by these caregivers. Dr. O’Brien describes
one mom who was intellectually challenged. There was
doubt about how much she could participate in rounds.
Yet she took in enough information to be a more effective
advocate for her baby, and learned to talk to health-care
professionals, Dr. O’Brien says: “By being involved she
was actually able to take her baby home with support.”