Every day, while seeing patients in the Intensive Care unit, I have family meetings and conferences to discuss the patient’s condition and outline the treatment plan. In many cases the diagnosis and the treatment are straightforward. If the patient came with pneumonia, intravenous antibiotics will be given and the gradual improvement is expected.

Sometimes, the patient’s condition is far from straightforward. Yet, the family’s understanding and “buying-in” into the treatment plan are important for the patient’s recovery. Using associations and analogies might help to effectively communicate with the family. Another technique that I found useful to “get through” to the family is repetition. Sometimes, you have to repeat the same thing over and over, using different words, of course, for the information to sink in. Let’s look at an example.

An 84 year old previously healthy male presented with urinary tract infection, acute renal failure and sepsis due to an obstructing kidney stone. The patient was started on intravenous antibiotics and the nephrostomy tube was placed to decompress the obstructed kidney. On the second hospital day his condition started to improve. His blood pressure, kidney function and fever have improved. His pain was controlled with oral analgesics.

Despite his overall recovery, on the third hospital day, the patient became restless, agitated and confused. The family requested an urgent meeting with the physician to find out why this highly intelligent retired college professor is jumping out bed naked, hitting nurses and does not even recognize his own wife. The family demands to know “what is going on and what is he being given by the nurses”.

The patient likely has ICU delirium or ICU psychosis. This is a poorly understood condition which is quite common among sick elderly patients admitted to ICU. Multiple factors contribute to this brain disturbance: infection, renal failure, pain medications and overall metabolic derangements including electrolyte misbalance. The list of precipitating factors goes on and on. Preexisting dementia is a big risk factor.

The mood in the conference room is tense. The family is visibly distraught and frustrated. Making a statement like “It is not surprising that your father/husband developed this condition since the brain is often affected when the rest of the body is sick” may ease the tension a bit. Understanding that this is quite common might make the family feel somewhat better.

Acknowledging that “yes, the pain medications that are being appropriately given to the patient might contribute to this condition as well as the kidney failure, infection, electrolyte disbalance…”

It is also important to outline the likely course of the condition by saying “Once overall clinical status has improved and his kidney function returns to normal and the infection is controlled, we will see a gradual return to the baseline”, thus, repeating the clinical concept again to facilitate understanding and retention.

At the end of the conversation the family was quite comfortable with the explanation and the treatment plan. The family expressed their understanding of the patient’s condition and precipitating factors. His wife also admitted that even though he has never been diagnosed with dementia, “his memory is not what it used to be”.

On the fifth hospital day the patient’s condition started to improve. His neurological status later returned to baseline. Hi was discharged home in good condition.