At some point in our lives, most of us will be visiting a patient in a hospital. What’s the etiquette for that visit? And wouldn’t you want your visitors, if you were hospitalized, to follow hospital etiquette?
By definition, the word etiquette simply means a code of behavior. Here are the 10 commandments that we really need to understand:
1. Inquire before a visit if the patient wants company. A phone call to the desk on the nursing unit is the first step. Another technique is to simply call the patient directly or a family member. A patient in misery and pain who is not sleeping may not want visitors. I recall that multiple family members descended on a woman patient who was mortified about the way she looked after surgery: no makeup, facial sutures, crude hospital gown. Be respectful of privacy.
2. The hospital visit is all about the patient, not about you. Start the conversation with this: How are you feeling? How are things going? Do not go into an elaborate discussion of your divorce, your new car, remodeling your kitchen or your own, similar surgery or health condition. Other visitors are not interested in this either, and it takes energy from the patient to pay attention to your issues. This is not the ideal setting to drill into political or religious controversies. And this certainly is not the setting to bring up contentious family issues.
3. Be attentive to the patient’s fatigue. If the patient seems to be falling asleep, if the conversations become fragmented, if the patient is distracted, take those obvious signals as a time to leave. Ideally, no more than two visitors should be around the bedside at a time. The greater the number, the greater the drain on the patient. In other words, do not overstay your welcome. Many patients will temporarily “rally” and put on a good face when there are visitors, but this consumes an enormous amount of focus and energy, and then the patient may crash.
4. Do not sit on the patient’s bed unless you’re specifically invited to do so. This is the only piece of private real estate they have (and most hospital beds are fine-tuned to the patient’s weight and can signal loudly if the patient gets up and should not). Find a chair, sit down, and make eye contact. Be engaged, be present. And turn off the cell phone. It is profoundly discourteous to be visiting the ill patient and then to glance at a text message or an email. The greatest gift is that you are showing up.
5. When the medical team comes into the room, respectfully and quietly step into the hallway. These conversations might be intimate and sensitive, and you may not be welcomed. Do not wait to be asked to leave. Simply leave. No drama, no discussion, simply step out. On the other hand, if the medical personnel is the technician to draw blood or nurse regulating one of the machines, it would be polite to ask if you should stay or leave. Be guided by the patient’s wishes and that of the healthcare team.
6. Anticipate your graceful exit rather than being asked to leave. “Okay, I better get back to work." Or “I have some loose ends to tidy up.” These are excellent techniques to the patient that the visit is “mercifully” coming to an end.
7. Specifically offer to do something: “What can I bring you? A newspaper, a magazine? A phone charger? Do you need anything from home and is there anything from work that would be important to review if you’re up to it?” I recall a patient who was frustrated by lack of sleep and asked the visitor to bring a set of eye shades, which were readily available at home.
8. If you anticipate returning, share that with the patient: “I am glad you’re on the mend. Let me come back on Friday just to see how things are going. Would that be okay?” On the other hand, if you will not be returning because of whatever, let the patient know: “I need to be out of town for the next week or so, but please keep me in the loop as the situation unfolds.”
9. Don’t bring food to the patient or food for you to eat in front of the patient. Patients are often on controlled diets or restricted from eating. How rude to eat a Big Mac in front of someone fasting before surgery. If you must eat, the hospital cafeteria is somewhere, as are vending machines and waiting rooms. Same with flowers (might be allergic) and candy (restricted diet) and stuffed animals (more clutter). Just your presence is enough, and if you feel you need to bring something, how about a heartfelt card.
10. Ask if there is anyone the patient would like the visitor to contact (or not). I vividly recall a politically prominent gentleman who was in a tight primary race for a very visible public office. He did not want the other candidates to know of his illness for fear that they would use this as ammunition that he was “unfit for office.” Clearly, this was not the case because the hospitalization was for a minor surgical procedure, but the details could have become distorted for someone else’s political purpose. Another approach that I have heard patients say is this: “Thanks so much for stopping by. I really appreciated it. Please keep my time in the hospital confidential at work since I do not want to make this a big deal.”
Until recently, the admissions office in most hospitals had a list of patients and their faith preferences. The pastor, priest, or rabbi could quickly scan the list and see if any of his or her parishioners were in the hospital. In general, patients appreciated the visit. However, with increasing concerns about privacy, the clergy may not know if their parishioners are in the hospital. It may be appropriate to ask the patient if they would like you to connect with the clergy and have the clergy arrange for visit.
Patients in the hospital (and especially in critical care units) may not want to see a parade of neighbors, coworkers, and members of the bowling team. Judge for yourself if an in-person visit is even necessary. Instead, wait until the patient is home and take over a precooked meal, plate of cookies, or offer to give the caregiver a break for a few hours and just sit with the recovering person at home.
Edward T. Creagan, MD, FAAHPM, a cancer specialist, is the first Mayo Clinic doctor board certified in hospice and palliative medicine. His new book, Farewell: Vital End-of-Life Questions and Candid Answers, is about navigating those precious last days, at the bedside, and saying farewell with hope, love, and compassion.