A Tale of Two Rounds: Managing Conflict During the Worst of Times in Family-Centered Rounds

> It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity. > > Charles Dickens1 Family-centered rounds (FCRs) provide a framework for structuring rounds to optimize care of the pediatric patient and provide family-centered care.2 However, the communication skills required to realize the benefits of FCRs are complex, and in practice, they can be easily derailed from their intended course. For instance, during a recent faculty-development session that included direct observations of bedside teaching, 2 rounding experiences stood in sharp contrast. In 1 situation, the intern expertly led the communication with the family, incorporated all team members into the rounds, and integrated teaching points on her physical examination findings for the medical students, all of which were made easier by a cooperative patient. As the 10-minute encounter concluded, the team and family were in consensus with the management plan and were in consensus that all concerns were addressed. The second experience was vastly different. The parents were already upset before rounds because a consulting service had visited earlier with recommendations that differed from those of the primary team, leading the family to question the primary team’s clinical judgment and communication skills. This seed of mistrust seemed to grow as the …