MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or B-square. The Medical School HQ Podcast, session number 70. Hey, this is Z-Dog MD, rapper, physician, legendary turntable health revolutionary and part-time gardener. And you're listening to the Medical School HQ podcast hosted by the irredeemably awesome Ryan Gray. Welcome back. I am your host, Dr. Ryan Gray, and I believe that competition amongst your premed and medical student peers is detrimental to becoming a great physician. In this podcast, we show you how collaboration, hard work, and honesty are critical to becoming a superior physician in today's health care environment. Hi, Allison. Hi, Ryan. Oh, that was loud. Sorry, folks, if that blew your e-drone. Sorry. You're just so excited about today's podcast, aren't you? I am. I'm just happy to be back again. Yeah, I know. Two in a row. That's, you know what? We have people that specifically ask for you. And I'm so flattered, and thank you, everyone. And I wish that I was on every week, but I also don't because I think you benefit from some great interviews and co-hosting interviews would be very awkward for me. That would be awkward. That's okay. Anyway, before we get in today's podcast, before we get into today's podcast, I want to again remind you that these podcasts are brought to you by freeemcatgift.com, where you can go and instantly download a free 30 plus page report on everything that you need to know about the MCAT. No, we don't give you the coolest, newest equation to help you on the physics section, but we do give you the information that will save you when comes time to saving for your whole application. So go to freeemcatgift.com and get that free download today. Yeah, great resource. So, what's going on? What's going on? What are we talking about today, Ryan? We're going to talk about family meetings. And this goes along with last week's podcast about end of life care. And how are you going to communicate everything that we talked about in last week's podcast during a family meeting and how to best set up family meetings? And I know this was something for you listening, Allison spent a ton of time during her residency working on a project all about family meetings and end of life care. So she's very passionate about this stuff. And that's why we're kind of teaching it to you guys so that you can learn from her wisdom. Well, thanks, Ryan. And I think it's just really good timing too because the match just recently happened and congrats again, everyone on your match. I hope you're all going to places that you were hoping to go to. And we think that providing this education and this basically information at this time will be very helpful to you, hopefully, because you're about to embark on your medical career as an intern. I guess you've already been in the midst of your medical career, but it's going to be even more real now. Now you're in charge as the intern, sort of, right? You're more in charge than you are as a medical student, but you're still part of a team. You are and we'll bring up teams in a minute. But, Allison, you had an interesting story from your internship that you wanted to share with the listeners. And hopefully, for those of you starting your internship soon or next year or in the next four years, whenever it may be, you can learn something from this story. Yeah, I think this is the story that I'll always remember and hope gives you some help too. So, basically, I was an intern and, of course, we all were as physicians, and I had just started. It was day three of my internship, so it was actually late June of, gosh, 2009. And it was late June because even though, technically, you think you start July 1, you actually start earlier than that, usually, because you have some orientation. Anyway, I digress. So, I was day three of my internship, and I was in the midst of taking care of a number of different patients. And I inherited a patient who had just recently come out of the ICU. I was actually accepting her as a transfer out of the ICU because I was an intern working on the medical floor at that point. And this woman was extremely sick. I will never forget her. She was so sick. She had a lot of really, really significant medical problems, and she obviously had been ill enough to just be in the ICU. But even that said, leaving the unit and coming to the floor, she was still very sick and probably could have gone right back to the unit. And I was really overwhelmed. I remember even just on accepting that patient, I had never taken care of someone before who was this sick. I certainly had seen very sick patients in medical school, of course. But again, when you become that intern and you're signing your name, comma MD, or DO, and you're, even though, yes, you're working under an attending residence and maybe even fellows and others, you're still primarily responsible, it feels like, for that person. And so, I was really overwhelmed by everything going on with her. And then, day three, again, of my internship, the family wanted to have a meeting. And I think the nurse approached me and said, "Hey, Dr. Cohen at that point," because I had not gotten married yet to Ryan, the lovely Ryan, irredeemably awesome Ryan Gray, as the dog would say. And so, they said, "Dr. Cohen, we want to have a family meeting. We need to understand what's going on now. We need you to walk us through everything." And I'm thinking, "Oh, expletive." Because not only was I already overwhelmed by this, but now I'm supposed to lead a family meeting. So, I thankfully had the wisdom, at least in that moment, to recognize that I was not going to be able to do this myself and that I needed help. And that's such an important thing, always, to remember in medicine, no matter what point you are at in your career. You have resources around you and get help when you need it. So, I went to my junior resident at the time and he was just wonderful and so supportive and said, "Yeah, this is crazy. We need to talk about this together and I'll happily certainly help you and guide you through this." And I've always been grateful to him. But it just goes to show that I could have gone in as an intern and just had a meeting. And I probably would have, it would have been abominable. It would have been awful. I mean, because I just was not prepared, right? I had never had any training about this. And everything we had talked about last week about how all this communication is really for the family members and the loved ones of the patient because that's what they're going to remember. If you went in like that, they would have had the worst memories of that hospital stay in the US as a physician and the hospital as a whole. Everything, yeah. It would have been a disaster because, I mean, the first part of it would just we would have been trying to explain to them what was going on with her. And I was already even overwhelmed by that. Never mind trying to help them understand what this means and where is this going and what is the prognosis and all of these things. And again, as a new physician, day three, you could be faced with a similar situation. And so we're hoping that what we're going to talk about in a little bit will be helpful to you. But nonetheless, just to round out this story, so my junior resident at the time and I, I think we certainly spoke with our attending about the patient and the meeting and the attending was not able to be there. But that's okay. In this, in this case, that was okay. And we went in and we had a meeting with them. And I didn't do it a lot of talking. The junior resident did a lot more of it. And that was okay. That was appropriate. And I was so sort of blown away because at the end of the meeting, they stood up and they gave me a hug. And I remember my junior resident saying to me later, gosh, well, you've got a hug out of that. And I was the one who was sort of leading it. And he was kind of being facetious. He didn't really mean it. But it was just, I think my hope had been to at least demonstrate compassion and empathy. And I guess to some degree I had, because the family felt taken care of and they felt appreciated and understood and heard and listened to. And, and thank goodness to my junior resident for helping me with that. But I certainly hope that all of you out there never get put in that situation again. No one was to blame. No one said, Allison, you must go in and have this family meeting by yourself. But that was the situation that I was put in, right? And so I hope that none of you has ever put in that position. But if you are, reach out and hopefully don't allow yourself to be part of the message. Yeah, really. Even if you think, Oh, I'm a doctor now, I can handle this. You don't want to do that. Don't be that person. Yeah, which goes back to again, we're going to keep referencing the last podcast. If you haven't listened to the last one, you can get it at medicalschoolhq.net/69. All right, so let's start talking about family meetings. What are some of the initial steps that you need to be taking when you know you hopefully you know you have a family meeting coming up? Absolutely. One of the most important things you can do for yourself is do a little bit of self preparation, do some homework. We all as physicians are running around taking care of a lot of patients and a patient that you're taking care of, a patient whom you're taking care of, may be at the forefront of your mind or not at the forefront of your mind depending on what time of day it is and what you're working on. So if you're about to step into a family meeting in which you're giving an update or one in which you're really having a critical conversation about the patient's current status and where things are headed, you want to make sure you know which patient you're talking about or you're about to talk about and their name and where they are and and key thing is to refresh yourself on what's recently just happened with this person. The last thing you want to do is go in and act like you're you're about to provide information and try to to have a conversation with the family and then look like you don't even know who the person is, that would be a disaster. So always prepare. That would be pretty bad and it might even be a HIPAA violation. Right if you start talking about the wrong patient in the wrong meeting. Oh dear. That wouldn't be good. So that's definitely important. One of the other important things that I think is key to preparing is getting with everybody else that has been taking care of the patient and we harp on this all the time that medicine now is a team sport that there are so many people that are taking care of each patient. And that's one of our biggest goals here is is helping you understand as a pre-med or as a medical student. It's not all about you. If you shut people out now and aren't very helpful in helping other pre-meds or other medical students and accomplishing their goals as well as yours, then how good of a team player are you going to be later on in your medical career. So understanding that there are nurses and social workers and other physicians, other specialists that are taking care of this patient and reaching out to them and getting information from them about what the family is like. Which family member is maybe the point, the one that you should be talking to, the one that maybe is the... The alpha dog? The alpha dog. What's the other term I'm trying to think of? The healthcare proxy. Yes. The proxy. Which one is the one that's actually making decisions? It's important and typically nurses a lot of times know this information. The social workers definitely know this information. So reaching out to everybody else that has a hand in that patient's care is very important and makes you look even that much more ready to speak to the family. Definitely. There's something that I always harp on all the time is that the patient's RN has to, must be a part of the meeting. The patient's nurse. Yes. RN as AKA nurse. RN just came out so fast that I never heard it. Correct. Thank you. Yes. The patient's nurse should always, always be a part of the family meeting. Why? Well, if you think about it, they're spending a huge percentage of their day with that patient. They may be taking care of five, six, seven, or maybe one or two patients depending on what level of care if the person's on a medical floor, a surgical floor or an ICU. But they spend way more time than you do with the patient and their family. And just like Ryan said, they may know that family is so much better than you do and really understand the intricacies and a lot of the finer details that we don't. And I think that's important for a medical student as well because medical students spend more time than maybe the residents or attending physicians. And so you as the medical student might have a little bit more inside knowledge that you can share with the team. Definitely. And the other really, really important thing about having a little huddle before going into any kind of meeting is that you don't ever want to go into a meeting and have it start and then realize during the meeting that people have different opinions who are amongst the medical team. So in other words, people, the nurse, the physician, the case manager, the social worker, if you have different viewpoints and you disagree about things, that's not going to go well. Because again, you're trying to provide a unified message to this family. You want to update them. You want to clarify the goals of care. You want this to be, we're here to help you. If it looks like, well, we don't even agree, that's not going to sit well with the family or the patient. It's not going to be comforting. If anything, it's going to be confusing. And that's something you want to avoid. So that's a whole separate and very important reason to have a little huddle beforehand. Yeah, good point. So what's another important thing as you're preparing for these family meetings or or in a family meeting? So one, one quick thing just to mention is be careful about where you're having the meeting. You don't want to have like a fly by essential critical meeting about a patient in the hallway standing next to a row of coffee cups. You want to have tissues available. These are all just things that are really important to think about. A lot of hospitals now will have dedicated family meeting rooms set up for this. They will. And as Ryan mentioned, with HIPAA, be careful too, because if you're running into the ER and there's a waiting room, and you don't necessarily want to have a big conversation or even an update with family members that are right smack dab next to other people, it's not, you know, you need to think about privacy. It's interesting. You mentioned that because that's what they do on the TV shows, don't they? The doctor comes out in his scrubs just out of surgery with the loved one. And he goes to the person in the waiting room and says, I'm sorry, he didn't make it. And everybody else is around. Oh, medical TV is such a joke. You know, I've been telling Ryan that I want to do a podcast episode all about all of the fallacies and just mistakes and it's dreadful about what they show on medical shows on TV like Grey's Anatomy and House. All right, we have to do that someday. We'll do it. Let us know, audience, please let us know what you think about that, because I would love to do that. I had to cut her off because she'll go for 20 minutes on this alone. Anyway, all right, let we digress. So think though about the setting. You digress. Yes, think about the setting where you're having this meeting. One of the other things that's really important as you're beginning to talk with people in the room after you've introduced everyone and they've introduced themselves to you all is to inquire about what their level of understanding is or not their level of understanding, but what is their understanding of what's going on with the patient? If the patient is part of the meeting, then you can ask the patient directly as well. But one of the pitfalls, if you will, that people make when they go into a family meeting or come in to give an update is that they rush ahead and talk about what's going on right now. And the family either missed out or they don't understand what you're talking about because they have just flown in or they've been around for a couple of days but haven't ever met you, you need to make sure that you're aware of what they know so far so that you don't make them more confused. And that's just really important to keep in mind. I think so. Always. I mean, I think right when you're in clinic with someone and you talk to them about anything, if they come in and they've injured themselves, the first thing you want to clarify is, do they know what's going on? Maybe they went too hard and they got a report back on a meat fracture and do they know what that means? How much have they Googled? No, seriously though, right? Because Dr. Google is super dangerous as we've talked about before. So if they've done a lot of reading before coming into a meeting and they think that they have a certain understanding of what they think is going on and it's completely divergent from what you know is going on. You want to have that information on the table to sort out, right? And there are times where they might know more than you. Yeah, I mean, you never know, that's why, again, you want all the cards on the table. You want to know what is the understanding at this time. Yeah. What's another one that we talk about a lot, right? So medical jargon. So I wouldn't walk in. Hopefully I've never done it. Hopefully, hopefully. I wouldn't walk in and talk to a family member and say, you know what, your loved one just had a, what would I say? I don't know, had a blood clot in their right MCA and is going to lose blah, blah, blah. I don't know, you can talk more about the stroke jargon. I don't know why I started thinking about strokes. But what's a super specific jargon about strokes that you would talk about, like that you would read in a scan? Oh, like, I mean, so saying something like, well, your grandmother has just thrown a clot from her, her femoral vein up through a patent frame in a valley up to her right, middle cerebral artery, and has now had a stroke involving, you know, the right frontal lobe, and she will now be paraplegic on the left side of her body for the remainder of her. I mean, this is like, her wernikies area is all blown apart. That'd be on the left MCA. Sorry, close. No, but seriously, I mean, can you imagine like that? I always think about this. Like if I went into a room with a lawyer and they just started like throwing out legal jargon, I would have no idea what they're talking about. Yeah, it's not fair and you can't do it. So let me translate what Allison just said. She said the patient had a clot in their leg. And unfortunately, that clot went to their heart and they had a hole in their heart and it went up to the brain. Which actually can happen, unfortunately. It happens a lot. It does. So but but it's all about how you frame things, right? So you don't want to hear jargon, you know, as as a patient, as a family member, you don't want to be providing jargon. It doesn't help anybody. There's there's actually a big push. And Allison disagrees with this of getting rid of a lot of the medical jargon that we use in the medical field of dumbing down the the communications in between doctors. Well, it's not to say that I think we have some fancy language that we need to know. It's because it's efficient. It's well, it's efficient, but also it's it's part of when and you all folks who are in medical school know this that when you become a medical student, you start learning a language. You're you're learning the language of medicine. Well, yes, a lot of it is based in Latin, but you're learning a new language. And it's part of how your your your framework for understanding medicine and pathology and and everything. And so I can't even imagine how it like, why would it work to be dumb down? Why would it help us? It's yeah, when when you dumb down is not the right term, obviously. Yeah, but but I think later, I think it's it's an extremely helpful thing as as physicians and health care providers to talk amongst one another in a language that we all understand. But it's not helpful to a patient or a family member, even if they're a health care provider. I mean, you know, even like I've talked in episodes or one episode earlier in 62 about my experiences as a patient with Crohn's disease, just because I have a medical background, when I go into my gastroenterologist's office and they're talking about Crohn's, I'm not savvy on everything GI related. So it's you know, just because I even am a physician, it doesn't mean that I'm going to be be all knowing about what I'm faced with as a patient, you know, of a gastroenterologist. So, again, get rid of the jargon. Just don't even enter it in the conversation. Yeah. All right. So, Riley, you just talked about that. So what else is important? So, so goals of care, and we talked about this in the last podcast episode, goals of care is an extremely important concept. And it doesn't necessarily have to enter into every family meeting because some are again about little updates, but these crucial meetings where you sit down and and you're thinking about that a patient you're taking care of is really suffering and not doing well, things are not moving in the right direction. And this is a meeting about redefining or maybe addressing is a better word, the goals of care. So if you haven't had a chance to listen to that episode, go back to episode 69 and have a listen. But but at this point in the meeting, once you've clarified the family's understanding and you're starting to talk about where things are, you then at some point want to talk about, well, what are the goals of care at this point? And just to highlight for a moment, so with goals of care, you may be confirming the patient's goals of care with the family. You may be clarifying what they would be in new circumstances now that you've provided some additional understanding of where this patient is and what's going on with them. So again, goals of care so crucial. And and listening, listening and answering questions, you need to at some point, right, have a pause where you listen, you listen to that family and that patient listen to their reaction. If you just breeze right through and you're sailing along and you're giving all this information, you're talking, talking, talking, you have to pause, right, because you have to to really get a sense of, well, what do they feel about all this? What do they think about all this? Yeah, there's a, there's a saying that I love that says, there's a reason we have two years in one mouth. I bet sometimes you think I have two mouths because I think so. But yes. Yeah. So listen twice as much as you're, you're talking. I think, especially during family meetings, taking the time to stop making sure the family is understanding what you're saying, repeat anything if necessary to help them better understand what's going on. Definitely. All right. And what's, what's next right? And this is a big one, I think. So I think the last thing we'll talk about is the fact that a lot of the time we're guiding the family on this journey, we're there to provide information to them and help them typically make a decision that will help with the next step of their loved one's care, whether that be starting more comfort care, like we talked about in the last episode, not withdrawing care, but changing our goals of care, and, or whether that's discussing a new surgery or a new treatment or whatever it may be, you're there to guide the patient typically, or the patient's family, and sometimes the patient. But I think that's, that's an important part of the process is it's not, not always, here's a bunch of information. Thank you. See you later. It's here's some information. Now what do we do about it? And there's this huge push and we've talked about it a couple of times before medicine isn't paternalistic anymore. It's not, I'm the doctor. Here's what we're going to do. It's, I'm the doctor. I'm going to give you as much information as I have available. You're going to use me as a resource, and we're going to make a decision together that's best for the patient. And so you need to help that family come up with the best decision for their family member based on your knowledge, their knowledge, and what's best for the patient. Yeah. And along those lines, the same, another important thing to think about is don't offer things that are unreasonable, right? So as their guide, and as someone who has a medical background and has knowledge that you're trying to impart on them, don't give them all of the information and then offer unreasonable things, which you don't think are appropriate just because we live in this world where autonomy, patient autonomy is so important. Just because patients can, and family members can really weigh in and make that decision with you, which is good. I'm not saying it's not. It's very different from that paternalistic situation that existed before, but it doesn't mean that you offer them everything, right? Because certain things would not be appropriate. It's like, I kind of say, I have this analogy. It's like, you don't offer medical treatments like pizza toppings. Do you want your cheese, your mushrooms, your offering things that are either appropriate and medically reasonable, and you're not offering things that aren't. Because that's just going to create potentially futile situations and really cause more problem than good. Yeah. Just because you can, doesn't mean you should. Right. And I think one thing, I think we'll end the talk there about family meetings. There's a ton more information on family meetings, but that's just a brief overview on it, some key points that as you're transitioning into your residencies and internships now, we'll hopefully give you a leg up and get you somewhat prepared to head into those meetings. But there's one part here that, along with the last podcast, number 69, and this one, we haven't mentioned. And that's the importance of from the minute the patient steps in the hospital, no matter how old they are or how young they are, understanding what their wishes and desires are as far as DNR, DNI. Oh, yeah. It's a huge thing. You're right, Ryan, that we have not addressed, really. It's such an important thing nowadays. And we all really should have health care proxies. We should all have living wills, no matter how old or young you are, because life is unpredictable. And there are quite a few patients that will come into the hospital with a health care proxy already, or with advanced directives, which mean they are already a patient who has designated themselves as I do not want to be resuscitated, should I go into cardiac arrest? Or I do not want to be intubated, meaning have a breathing to put in if I can't breathe on my own. So it's so important to address that and know that from the get go. And sometimes, and oftentimes in family meetings and conversations where there is a shift in goals of care, patients may become DNR, DNI. And so that's a really important thing to be aware of and to recognize there, there have been situations in every hospital. I mean, where a patient was thought to be full code, meaning that you would do everything in your power to try to prevent their death. You would put in a breathing tube, you would resuscitate them, you would shock them. And that patient actually was DNR, DNI, meaning they didn't want any of that. And that's just such an unfortunate situation that you don't want to ever have happened. So DNR, DNI, and that is all part of the goals of care and what are the advanced directives. So be aware of those things. Thanks for bringing that, Brian. Very important. Yeah. All right, folks. So that was all about family meetings. If you're interested in knowing more about this, as always head over to the show notes medical school hq.net slash 70 as an episode 70 and leave some comments. Alison is very invested in family meetings and end of life care. She's she's still involved in a big project at Mass General, all about this kind of stuff. So if you have any questions, if you want any more information, feel free to reach out through the comment section or through our contact form on the website. Alison, tell people where they can find you on Twitter. Ah, so you can find me on Twitter by typing in @aelson_medicalschoolhq. MS HQ close. That was a test because Allison's not on Twitter enough. I can't believe he's just testing me on the air. Yeah. So I'm at medical school HQ. Alison is at Alison underscore MS HQ. All right. Ryan's clearly made a point that I need to get on Twitter. So I'll be on more. We'll get her on more. That's all right. And as I mentioned at the beginning, go to free mcatgift.com to download that free 30 page 30 plus page report all about the MCATs and how to how to maximize your studying and your everything with the MCAT. Go get that free resource. That's awesome. Yeah. And so hopefully, as always, this information has provided some valuable insight into everything that goes on in the life of a doctor. And hopefully you can take it and use it and learn from it. And as always, I hope you join us next week here at the medical school headquarters. So Allison, we're still recording. How you doing? Oh, I'm good. You told me I wasn't allowed to talk. You were not on a talk. Yeah. No, we're still recording. What are you recording? So this is a little bonus. What's going on in our life? This is like in Ferris Bueller, where he comes back at the end. Are you still here? I've done this one other podcast. What is going on in our lives? We're about to have a big, pretty big life-changing event. It's as big as life-changing events can get. Yeah. So if you're listening to this, Allison and I had a baby in the last two weeks or so. This is pretty crazy. So our goal is to continue to release these podcasts on a weekly basis. We might miss one or two here or there. Hopefully, we don't. Please forgive us if we do. But go send a congratulations to Allison for going through all of that. She's got all the hard work ahead of her. Right, Allison? Yes. That's what they tell me. But congratulate Ryan, too. It's a big deal for him. Yes. So you can go on Twitter. That'll be a good reason for Allison to get on Twitter. So we'll have more information. We're recording a couple of these ahead of time so that we can kind of relax once the baby comes. And we'll talk to you afterwards and let you know how how everything went. You
