Belated blog

On a gerontology prac I was asked to attend a 'family meeting' about one of my patients. I had never come across these before. My supervisor explained that the family members meet with the health team to discuss an important issue about that patient. In this case it was simply about readiness for discharge. She recommended that I prepare a brief progress report supported with objective measures. During the meeting it became apparent that the family were very apprehensive about the patient's discharge, fearing that another fall would occur or exhaustion would prevent him from coping alone at home. The patient became very submissive around the family. Either standing up for himself wasn't the normal family dynamic, or their fears genuinely rubbed off on the patient. The family's expectation was that the patient be functioning 100% normally before discharge. From an allied health perspective their apprehension was completely unjustified, as the patient's performance was already at a much higher level than normally required for discharge. Our perspective is influenced by a health system that constantly requires beds be made available for new patients, however, this patient had very little room for further improvement in the hospital environment. 

Our persuasion efforts included to gently explaining that a normal level of functioning can not be achieved in an environment where so much help is available, and that the initial difficulties (eg exhaustion) would not compromise the patient's safety, as he had good common sense about his own limitations, and had been provided safer alternatives for more difficult tasks. It felt like a court of law. In their fear, the family made unsupported claims about the patient's current level of independence. If my supervisor hadn't recommended that I prepare, my comments wouldn't have been convincing to the family. Being able to read a list of objective measures in terms meaningful to the family is more reassuring than simply disagreeing with their claims. I found it hard to 'present my case' without guaranteeing safety for the patient at home. It had to be explained to the family that risk of falling can never be totally eliminated, without substantiating their fears. 

This experience has taught me to always be prepared for a situation where you must display your familiarity with a patient's progress. It has also taught me that I must be confident in my opinion of a patient's rehab status. The hardest part of the experience was not being intimidated by the family, and reminding myself that if something did happen to the patient after discharge, I can't blame myself. I rehabilitated the subject as thoroughly as I could and beyond that it's out of my control.

A compromise was eventually reached between the family and the doctor to stagger the discharge over a few days, with intervals at home and in hospital.