Dealing with differing health beliefs and values - empathic

INT. OFFICE - OFFICE HOURS
HOSPITALIST and DEPT HEAD are sitting across the desk from each other

DEPT HEAD

Well thanks for coming in to see me today.  How are things going?

HOSPITALIST

(tired) Oh, you know, ok I guess.  Too busy as always -- can’t stop thinking about taking a month off with Diane and the boys.   Two more sleeps! What's up?

DEPT HEAD

Yeah, I hear you.  Listen, the reason that I wanted to speak with you today, is that I've (slight pause) well, I've received a complaint from the son of a patient you saw last week, Mrs. Bergman.  She died yesterday, and the complaint was on my desk this morning.

HOSPITALIST

(stunned)

Oh....

DEPT HEAD

You saw them to ask about goals of care, and apparently what the son took away from it was that the hospital was refusing to treat his mom.

HOSPITALIST

(rubs forehead)

Oh my gosh, I knew this was going to be a train-wreck

(sighs, seems to be searching for words)

DEPT HEAD

(waits to see if the hospitalist has more to say)

Were you maybe feeling a bit apprehensive about this situation?

HOSPITALIST

(sighs continues - tired, rather than angry)

Ok.  So here's what happened. I've been on-site overnight, and I get a call from a nurse on 5 North who is coming on shift at 7 am to find the patient's son climbing the walls because his mom has been admitted to "alternative level of care" which, if I remember,  happened only because there wasn't a bed in orthopedics.  Family doc is on vacation, and no one has documented a discussion about goals of care.  And with good reason, too, because we pretty much all know they're going to want everything done for this poor old soul.  Anyway, the nurse kindly reminds me that the patient has a life-limiting illness or three, and the policy says...blah blah blah.  So I agree to come down and talk to them.
When I walk in the room, I have every intention of just confirming what I already know they will want, but I look at the patient and think to myself: I owe it to this poor lady to spare her a lot of suffering and indignity.  So I think, "I'm going to just try to explain the options before they tell me that they want every possible intervention".  So I try to do that, and before I can finish a sentence the son is going bananas, accusing me and the hospital of refusing to treat his mom, and threatening  a formal complaint. So I just back away, and say "listen, if that's what you want, that's what we'll do."  I was just trying to help.

DEPT HEAD

Wow, it sounds like the whole thing was pretty stressful for you.  I’m wondering if you’re feeling upset, and maybe wanting to have your helpful intentions understood?

HOSPITALIST

(Sighs... more deflated than defensive)

Well yeah, I guess so.  Not upset really, just discouraged.  I really do feel for the guy though.  I know that it’s devastating to lose your mom... and who knows what else is going on there?

DEPT HEAD

So you’re feeling pretty discouraged.  And, I’m also hearing how much you care about the patient and her family, and I’m wondering if you would like some acknowledgment of that?

HOSPITALIST

(sighing, showing some emotion, some agreement)

Yeah, exactly.  I really didn’t want it to end like this.  I was just trying to do everything I could to help relieve her suffering.
But you know, Jill, also I’m just feeling too exhausted to respond effectively to a complaint right now.  Can we put this on hold until after I get back from my vacation?  I think ideally I'd like to sit down with the son and the family doc and put things right, but I just can't even think about doing that right now.

DEPT HEAD

Yeah, I hear you, sounds like you’re pretty tired right now and really looking forward to some rest and time away.  I also understand you want to take time to make a thoughtful response to the son, so that he understands the respect that you have for him.  And I really appreciate that. (pauses)
I also know that you’re going to be away for a month, and I’m thinking that Mr. Bergman may want a response, some - acknowledgement a bit sooner than that.  I wonder if we can find a way to meet your need for rest, and at the same time take care of what I’m guessing are his needs right now...

(pause to see HOSPITALIST’s reaction)

HOSPITALIST

(nods, looks dubious)

DEPT HEAD

Here’s one idea: if I could write something up based on what I’ve heard you tell me today, would you be willing to check it over and see if it says what you’d like it to say?

HOSPITALIST

(sighs) Honestly Jill, I’m not sure.   I just don’t know if I have it in me right now.

DEPT HEAD

Ok.  I understand how tired you’re feeling right now, and... maybe a bit overwhelmed.  I’d really like to help.  How about if we work on it together right now for just a few minutes?

HOSPITALIST

Ya, ok. Sure.

DEPT HEAD

(turning to computer keyboard) Ok, I’m going to start typing, and you just let me know...(audio and visual fade as they start working on response).