As a hospitalist, you’re the central coordinator of inpatient care, which means you’re also communicating with caregivers and patients’ loved ones. Your role is unique and multidisciplinary.

“Unlike subspecialists who focus on one organ system or procedure, hospitalists manage the entire patient,” said John R. Adams, MD, executive hospitalist medical director, UNC Health Rex in Raleigh, North Carolina.

Hospitalists are adept at balancing acute needs, chronic conditions, and the emotional impact of hospitalization, he said. “In many ways, we serve as the ‘point guard’ for each patient’s care, directing the flow between specialties, ensuring priorities are addressed in the right order, and keeping the patient’s overall well-being at the center of every decision,” he said.

Because hospitalists are physically present in the hospital and spend significant time with patients and their families, they are uniquely positioned to monitor day-to-day changes in condition, said Adams.

Obtain Patient Consent Prior to Engaging in Discussions

It’s best practice to ask patients who they want you to discuss and include in interactions and discussions.

“It is part of my personal routine to re-verify who their emergency contacts are and to ask them if it is okay, at least to update them of how they are doing,” said Kristina Balangue, MD, clinical assistant professor of geriatric medicine at the University of Arizona College of Medicine, Phoenix. This verification exercise leads to a more fruitful discussion, she said.

Ethics Regarding Conversations With Caregivers

It can be appropriate to do so, if your patients have said that they are comfortable with doctors updating the caregivers about their status, said Balangue.

“I usually advise to periodically check in with our patients and caregivers if they are continuing to be comfortable to be updated about the current status of the patient in the hospital or check in with them if the information they are sharing is okay to be shared to one another,” she said. 

Caregivers can be an important source of information, too, she said.

“Caregivers potentially offer valuable information about how our patients are doing that can give more effectiveness and depth to our medical management. It is all about fostering an environment where people are comfortable to let their medical professionals know about certain concerns that may be relevant to the care of the patient,” she said.

Protocol for Patient Briefings

With the patient’s permission, including family members or caregivers in briefings can significantly improve outcomes and reduce confusion.

Many hospitalized patients may not understand, comprehend or remember what’s been discussed when their hospitalist is at the bedside, so sharing updates in beneficial.

“Involving caregivers helps ensure that the ‘four W’s’ are clear and recorded,” Adams said, referring to who, what, when, and where. “In every patient or family interaction, it is important to clearly state who is providing care, why the patient is admitted, what interventions/treatments have been enacted, and when the patient may be discharged.”

Implementing Plans for Support Services

Hospitalists can link patients to resources such as social workers, dietitians, occupational therapists, or mental health providers. Because scheduling these meetings can be challenging, an effective approach is to first confirm patient and caregiver availability. “Then, hospitalists should consult all appropriate services, delineate the questions for each service, and coordinate a specific scheduled time for a group discussion between these services and the patient and caregiver,” said Adams.

Adams and Balangue reported having no disclosures.