Critical Care Medicine

Today, rounding in the intensive care unit, I was able to spend more time watching the activities of the young in training and was struck by the changes (good ones) that have evolved since I was a resident rounding on the critically ill with my senior attending physicians. The tradition then and into the majority of my years as a practicing physician was to make the official bedside rounds "closed"; that is only for the doctors, medical students, and the nurse taking care of the patient. Nowadays, a flock of people hover around the door to the patient's room. In addition to the doctors, there is a respiratory therapist, a pharmacist, possibly a social worker and to my great surprise, significant others of the patients (spouse, partner, parents, or grown children).

At first I bristled at the idea of these all inclusive bedside rounds particularly in the intensive care unit. I told myself that families had no business listening to the hum drum reality world of hospital rounds which are nothing like what goes on in "E.R." or "Grey's Anatomy". Besides, wouldn't the rounds take forever with each medical term, abbreviation, or inside communication needing to be translated for family? And then, what happens when we simply "don't know what to do" about whatever situation exists; how do we brainstorm options without looking like we are total idiots and poorly qualified to be making major decisions in the care of loved ones? Wouldn't we have to be "on guard" and pay attention to every word, innuendo, and stray comment so as not to cause confusion, misunderstanding, or at worst anger and pain in family or patient (who in some cases is able to listen in, depending on the severity of illness)?

But today, as I watched and participated in a group discussion of a complex patient with both of her parents present, I witnessed a very professional, thorough, and important gathering of key players (family included). Medical terminology flourished, give and take discussion (teaching points) occurred and it left me quite impressed. The work flow and decision making occurred and I was left with the sense that including family in the process was more helpful than a hindrance. Times change, styles change, and we move forward, hopefully for the better.

I know that these doctors must convene at a later time to share their thoughts about the care of critically ill patients and allow the unknowns of medicine the opportunity to flourish. There is so much about the critically ill that we can impact but also much that we are forced to accept as just "what is". To accept that we cannot be healers at all times, that we may chose a path that ultimately was likely not the best one for our patient, and to teach and be taught behind "closed doors" is also very important. This, in my opinion, is work that must be done outside the patient's room and away from family.

'Tis a balance. But, I must say that I liked the way family was included into these very thorough bedside rounds. I believe this is happening more commonly, especially in the intensive care unit where such inclusiveness on the critically ill was never felt appropriate, until now. Progress indeed.