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Financial Times Weekend Magazine | September 2, 2011

By Kiran Gupta

Learning to earn the trust of relatives is vital in providing the best possible care

Many US medical schools prepare students for patient interaction by teaching them how to take a medical history, perform a physical examination, and conduct themselves professionally. But I received little instruction regarding interaction with those most deeply involved in a patient’s care – their family.

Families are often patients’ most forceful advocates. As doctors, we appreciate that they care for our patients when a hospital stay ends – picking up medications, preparing meals. Most often, our relationship with the family is collaborative. But no matter how well intentioned we are, the nature of our healthcare system – limited resources, multiple caregivers and frequent shift changes – can create an emotionally charged situation in which our patients’ strongest allies seem to become our greatest adversaries.

I was covering the night shift. The day-shift resident had left me with information about his patients, in particular Mrs D. This elderly woman had been transferred from another hospital for further evaluation because her blood was mysteriously clotting. Commonly used blood-thinning agents had done nothing. Several of the clots had travelled to her brain, causing multiple strokes and neurological damage.

The day resident was concerned about Mrs D’s family, who were very involved in her care and growing increasingly anxious. Prior to leaving, he introduced me to them. The family was clearly distraught over Mrs D’s slurred speech and gaze deviation, so I assured them that I would page neurology immediately if I suspected further strokes.

Less than an hour later, I was paged to come urgently to Mrs D’s room. My immediate thought was that her condition had worsened. Instead, the family had become progressively upset about Mrs D’s condition and had decided that they wanted to transfer her to another institution. The nurse looked overwhelmed. It was nearly midnight. As there was nothing I could do to improve Mrs D’s prognosis, I did the only thing I could – sat down to speak with the family.

Closing the door to a private meeting room, I was inundated with questions from eight or so relatives: “She isn’t getting better, so why don’t you do something? Why isn’t she in the intensive care unit? How come the doctors keep changing? We want to transfer her to another hospital.”

I knew I had to handle this delicately. I explained that transferring someone as sick as Mrs D in the middle of the night on a weekend was not advisable. “Well, she might be dying so you need to do something.” I kept quiet. It became clear that this was the first time it had truly occurred to them that Mrs D might not recover. I listened to their concerns, at times interjecting an expression of sympathy or support. After nearly an hour, the tension in the room abated. Finally, they thanked me and left.

Mrs D’s primary medical team had done everything they could to address her family’s concerns, but it took that late-night discussion for them to accept the limits of our medical abilities. As doctors, our relationships with patients’ families are not always easy. Sometimes, despite our best efforts, frustration, stress, and grief will strain our interactions. But communicating often, with honesty and empathy, is essential. While formal medical education may not prepare us for these midnight moments, learning to earn the trust of the relatives is vital in providing the best possible care.

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