“How do you feel about going home tomorrow?”
Most hospital patients are elated to hear these words, especially after recovering from a long illness or serious accident.
But there is a nuance in this conversation that a lot of people don’t talk about: the anxiety that settles in when the notion of going home becomes reality.
“I’ve looked forward to going home for so long, but now that it’s here, I feel overwhelmed just thinking about it,” one patient recently told me.
Going home is a drastic transition. Without a physician or nurse to deliver their medications on time or to answer a call-bell, patients and their caregivers are suddenly tasked with full autonomy and responsibility that isn’t always welcome.
This can make every decision look enormous.
“If I am not feeling any pain, but my prescription says to take a pill every four hours, can I hold off?”
“I know I am supposed to get adequate nutrition, but if I feel too full or bloated, is it OK for me to eat less?”
“Can I walk for 10 minutes if I don’t feel weak or short of breath? How about 20 minutes?”
At first, I had a hard time understanding why patients question themselves so much.
Of course, you can take fewer pain pills if you’re feeling fine, eat less if you’re too full, or walk as long as you feel strong on your feet. Do these questions even need to be asked?
Then I took a look at the questions that I was asking my chief residents as I was going through my own transition as a new intern.
“Is it OK if I give this patient a higher dose of Tylenol if the current dose is not controlling his pain?”
“The patient is feeling bloated. Would it be OK for me to slow down his tube feeds this evening?”
It is natural to be unsure during transitions.
If our patients are not feeling confident about taking care of themselves after leaving the hospital, then it is our job to empower them during this particularly vulnerable period in their lives.
In the same way, my chief residents have answered even my most inane questions without condescension or frustration. Their patience is helping me to grow more independent.
We must not mistake uncertainty for ignorance. My patients and I both ask basic questions not because we don’t know anything, but because we cannot afford to be uncertain.
Since starting my internship, I have watched physicians visit patients several times a day, always answering their questions. There are social workers and case managers available at all times on every floor. Nurses use the Transitional Care Model to help create detailed, personalized care plans for going home, and teach patients and caregivers what they need to know to continue care at home.
One of the nurses on my floor came to work a few hours early one morning to go over how to change tracheostomy dressings with the patient’s wife, because neither patient nor spouse felt ready to go .
We all know that patients who go home knowing exactly what they need to do are less likely to have to come back. They – and new doctors like me — are able to move beyond uncertainty because someone took the time to listen.
Jason Han, M.D., is a resident in cardiothoracic surgery in the Perelman School of Medicine at the University of Pennsylvania.