As hospitalists, you’re juggling a heavy caseload of patients, maintaining patient specifics, and navigating several medical teams, all while providing excellent and personalized patient care. Still, while interacting with your patients, it’s important to take notice of specific signals that may indicate a patient is scared, lonely, or isolated. 

A physician can take every patient encounter as an opportunity to engage meaningfully with the patient, said Laine Young-Walker, MD, chair of the Department of Psychiatry and professor of psychiatry at University of Missouri-Columbia School of Medicine. “It is often about the quality of time and not the quantity of time,” Young-Walker said. “Spend a few minutes getting to know the person as a person and not only focus on the health condition that is being treated. It will mean a lot to the patient that their physician took the time to relate to and get to know them.”

With this advice, and to better personalize and understand the nuances of recognizing specifics, experts shared directives that can offer guidance. 

Personalize Patient Care 

The interactions with your patients generally focus on daily health updates; however, your discussions with your patients could be more personalized, even with brevity in mind.

“There are certainly ways to make your interactions more personal without investing large amounts of extra time,” said Alden Littlewood, MD, chief of psychiatry, University of Maryland Medical Center Midtown Campus, and assistant professor, University of Maryland School of Medicine, Baltimore. To begin with, sit down to raise the patient’s comfort level. “Patients perceive doctors who sit while interacting with them as having spent more time with them than if they had been standing up,” said Littlewood.

With a patient at greater ease, they could be more forthcoming about their feelings and fears. As a hub in your patient’s care, this approach can facilitate more conversations about their inpatient experiences. 

“Communication is key,” she said. “Multidisciplinary team rounding can also make patients feel more seen and heard by ensuring that the patient and the entire team are on the same page.”

It’s also important to take the patient’s perspective into account. “When discussing care, remember that most people only remember a few details of a complex conversation afterward, so highlight important points,” Littlewood said. “Avoid jargon, and don’t assume that a patient who is nodding understands everything you said.” 

And ask them to recount it back to you, as this measure can help. “When sharing new information, ask the patient to say back to you what you shared, in their own words,” she said.

How a Hospitalist Can Introduce Support Services 

Patients don’t expect you to have all the answers, but it’s helpful to get to know the social work and case management team at your hospital, Littlewood at University of Maryland School of Medicine, said. “Ask questions about what services they provide and what resources they can (and cannot) connect people within your community. The goal is to have a realistic overview of what might be possible, not necessarily to have a solution for every situation,” she said. 

Keep in mind that patients may also be guarded about their needs or about sharing certain details about their lives. “Be honest at the outset about what you can and can’t keep confidential and honor limits,” she said.

What About Medical Interventions or Mental Health Counseling? 

Littlewood said loneliness, sadness, anger, worry, and fear can all be totally normal responses to stressors like illness and hospitalization. 

“Patients experiencing these emotions may or may not meet criteria for mental health diagnoses. If you aren’t sure, or if you think these feelings might be interfering with the patient’s care or functioning, a psychiatry consultation can help, so as long as the patient is open to it,” she said.

Regarding medications for depression, anxiety, or other conditions, she said they may or may not be helpful to start during an acute hospitalization. “In a similar way, most talk therapy takes time to be effective. If the patient is unlikely to remain in the hospital long, then as long as there are no safety concerns, one of the most helpful things a hospitalist can do is to help the patient work with the team to get connected with longer-term outpatient mental health care,” Littlewood added.

Bedside Strategies to Offer Patients Who Are Afraid 

As a hospitalist, you understand the dynamics of patients who are inpatient. 

“Unfortunately, hospitalization is a time of decreased control and decreased independence,” Littlewood said. “We all want to be in control of our own lives and our futures, and there is evidence that people have better physical and mental health outcomes when they have increased feelings of self-efficacy.” 

Keep in mind it can be scary to depend on others if a patient isn’t used to this dynamic. “Sometimes this can lead to frustration or withdrawal, or even to symptoms of depression, anger, or anxiety,” she said.

What About Helping Patients Who Are Lonely? 

Once you have confirmed a patient is feeling more isolated than they’d like, do what you can to encourage visitors, Littlewood said. Beyond that, explore ways to support use of technology to connect patients to friends or loved ones, and online support groups may be available for those with limited contacts.

Other Mental Health Markers to Watch For 

As part of your assessments, understanding more about the scope of mental health is vital. Look for specific signals. Some of the symptoms of depression include disruption of sleep (sleeping more or less), alteration in appetite (eating more or less), diminished interest or pleasure, increased guilt feelings, reduction of energy, difficulty concentration, psychomotor agitation or retardation, and suicidal thoughts, said Young-Walker.