Much has been written on the topic of prognostication; in general, physicians do a lousy job both in initiating the conversation and providing any useful information to patients and families. In the current issue of Newseek(August 22, 2005) there is a poignant article (Page 16) written by the wife of a patient who died following a sudden illness. She describes her difficulty in tracking down doctors who would give her useful prognostic information; the title says it all, "I shouldnt have had to beg for a prognosis". I used the article as part of our Palliative Care Grand Rounds this week, distributing copies and taking a few minutes for learners to read and reflect on the article. Successful models do exist for enhancing information flow in the ICU setting. Last year I visited a hospital in Connecticut where families were specifically invited to be in the room during rounds in the surgical ICU--by all accounts a positive experience for all involved. Other hospitals have established routine family conferences for updates or decision making, others have criteria for palliative care or ethics consultations. The key to improving information seems to be a combination of education and systems change--improving the process of information delivery through a coordinated, systematic process. Does anyone out in blog land have a successful model to share?
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