Insights on Facilitation: Closeness and Intimacy Through Virtual Facilitation

PCP’s Insights series was created to bring an interprofessional and diverse range of stories as told by the PCP Network into our Relational Response Initiative (RRI), a program originally designed to deliver our Relational Leadership curriculum virtually to support healthcare professionals and medical students during COVID-19. In that time, the tragic deaths and unconscionable acts of racism and violence against Black communities recommitted our focus and purpose for the PCP Insights series. Please contact us to share your story about your passion or work to advance health equity, racial or restorative justice, and to help PCP lift up stories from Black communities.

COVID hit our country when I was just over halfway done with my residency in family medicine at the University of North Carolina. Up to this point, I had done a fair amount of inpatient medicine and thought I had the general flow down: get to the hospital early; drink my coffee while reviewing charts; pre-round with my patients; get some teaching in; round with my attending; then take care of various tasks throughout the day before signing out to the night team at 6 p.m. sharp. Coronavirus mandated that the fault lines of communication — seemingly so distinct — be completely reconstructed.

Now, patients and families are forced to separate once a patient enters the hospital doors. Many consultants see patients virtually. All providers and staff stay six feet apart and wear masks. Communication in the context of patient care looks completely different than it did four months ago.

A vivid memory of this transformation in care delivery occurred in the middle of my second week on service. When I first started to take care of Mr. George, he was a series of numbers: sodium of 157, ph of 7.17, lactate of 3.0. Elderly, nonverbal, and frail, he was unable to provide a verbal history. But even with his strained language, there was still a vivid mind at play. Over the course of the week that I cared for him, I learned a tremendous amount about his history, even with his terminal condition. Rather than family members at the bedside, often visiting one by one with stilted opportunities to engage with our team, I was able to designate a time each day that I would conference by phone with his daughter and his son. My attending would join us when he could.

The children shared stories of what Mr. George was like in his youth, their concerns about the rapid progression of his illness, and their uncertainty and disagreements regarding next steps. Perhaps it was the privacy the phone line provided, or maybe the consistency with which we engaged in these virtual updates. Regardless there started to be a sense of familiarity, closeness, and understanding that undergirded our phone sessions. Mr. George came alive in my mind, and through these conversations I understood the pain his children felt as they continued to process the newfound severity of his illness.

While we prepared to transition Mr. George’s care to a skilled nursing facility at the end of his hospital stay, my attending and I organized a phone conference with both of his children, the palliative care team, and the hospital chaplain. With the palliative care team leading the charge, we walked the children through all of our findings from his hospital stay, incorporating recommendations that we had virtually obtained from several sub-specialists who had been consulted on the patient. Our conversation was not done in person, but instead done with each of us sitting in separate physical spaces. Despite the distance, our interactions felt incredibly intimate — the logical conclusion of the days we had spent getting to know one another and Mr. George. Mr. George’s children were given the space to ask questions, share lingering fears, sit in silence, console one another, and come to a shared vision of what was in Mr. George’s best interest moving forward. Collectively, with his children leading the charge, were able to determine what Mr. George’s care plan would be after leaving the hospital.

Facilitating close conversations can create intimacy in our connections and also bring us closer to one another. Even amidst COVID-19, there is an opportunity to do this powerful and meaningful work of relationship building. My time with Mr. George and his family showed me the power virtual facilitation allows, enhanced in a pandemic that forces us to think about communication, safe spaces, and conversation in new ways.