The Rabbi or the Resident?

In more and more circumstances, one patient is no longer taken care of by just one doctor. This is particularly true if the patient is older, has multiple medical illnesses, or is admitted for critical care. In the latter circumstance, friends, relatives, and other surrogates descend on the ICU befuddled, confused, and scared and are desperate for information and the prognosis for their loved ones.

Emphasis has been mostly on the patient experience. But, in so doing, we have neglected the doctor experience, failing to recognize that one derives from the other, and the family/companion/surrogate experience as a member of the patient team.

I've had the recent unfortunate experience of witnessing a friend undergoing critical care of a life threatening illness and have made the following observations (along with my wife):

1. We need to pay more attention to the needs of the patient, family, and friends team.

2. The ICU room needs to accommodate not just the medical providers, but those who may be spending large amounts of time there too. They need a place to decompress while they are sitting vigil.

3. Name badges and identification should be mandatory for all members of the ICU team.

4. Care team members should dress the part and respect infection control procedures.

5. Sometimes patients just want to maintain their dignity, which can be literally stripped from them while doctors and nurses attend to their medical needs and patients do not want well intentioned visitors. Visiting hours and privileges should be clearly noted and posted.

6. An ICU concierge, possibly a volunteer position, should be available to relieve the burden of the next of kin from making travel arrangements, picking people up at the airport, finding local restaurants or hotels or temporary athletic club passes where they can exercise to decompress.

7. Online and web-based technologies should be used to provide secure messaging, chats, and updates of the patient's condition and notices about "what you can do to help"

8. ICU "waiting rooms" should be built to accommodate the needs of families who will spend a lot of time there. Desks, private areas, wifi, more comfortable beds or cots, and shower facilities would help and they should be exposed to light, not a dreary, dark hallway that makes an already depressing situation worse.

9. Clinical social workers should be available to help with counseling needs or help resolve dysfunctional family social dynamics during a stressful time.

10. ICU dos and don'ts should be clearly posted.

If you are visiting or supporting someone in the ICU, at the least you should know whether the person seeing your relative is the rabbi or the resident. We owe that not just to the patient, but to the patient's team too.