Every day, there is uncertainty in medicine. For instance, I can’t say with certainty that, if we start this antibiotic, the ear infection will definitely get better. And that uncertainty is sometimes unsettling, even in situations that are fairly low stake.
There are, however, many situations when the stakes are high – life or death. And it can be difficult, especially since we want to be honest with families, while also not robbing them of all hope.
This week, Pediatrics is early releasing a Family Partnerships article that outlines how a care team, starting in the emergency department and moving through the pediatric intensive care unit and the inpatient ward to hospital discharge, was able to navigate that difficult situation, and how the honest discussions empowered the parents of an infant facing a potentially devastating outcome (10.1542/peds.2022-059783). Dr Carolena Trocchia, her colleagues at Johns Hopkins All Children’s Hospital and Johns Hopkins School of Medicine, and the infant’s mother, in this article that is aptly entitled, “Navigating Uncertainty in Medicine with Our Families” describe how they worked to build trust and keep the lines of communication open.
When we care for critically ill patients, we constantly have to pivot, as the patient’s condition can drastically change from day to day, or even from hour to hour. And just because the patient is getting better, it does not necessarily mean that it becomes easier for the family. In fact, the infant’s parent noted, “It seemed out conversations became harder the more [our child’s condition] improved.”
As you read this article, think of your own personality and what you can take away from this. For instance, many of us are uncomfortable with admitting that we don’t know the answer. This article tells us that being honest with the families sometimes means admitting that we don’t know, and that admission sometimes can increase the trust of the parents.