This article would help healthcare professionals understand the importance of communication to reduce and eliminate confusion and aggressive reactions in patient-care.
When the patient is unwell, it is the family who acts on behalf of the patient. Especially in the Indian context, you don’t treat the patient, you treat the family. To the extent, most of the decisions about the patient are taken by the family of the patient. On the other side, studies suggest, we look after the patient but refuse to attend to the family of the patient or address their concerns. Communicating with the family of the patient is important as family being the primary caretaker of the patient needs to be not only engaged in patient care but also need to be explained and updated on a regular basis about the patient’s ailment, recovery and prognosis.
Some of the practitioners are really good at developing rapport with the family, while others find it cumbersome and unnecessary. Developing rapport with the family is a helpful way to earn cooperation, compliance and adherence to the treatment protocol. It also helps win their trust and avoid aggressive and violent reactions. Following are some of the helpful guidelines to communicate with the family of the patient:
1. Identify the primary caretaker: It is helpful to identify the primary caretaker/s of the patient. Through little effort and observation, you will be able to identify the primary caretaker/s of the patient. It is better to communicate with the same set of members to avoid any communication gap. One can also ask the patient and family whom they wish to identify for regular communication. This will also save you of the hassle of communicating with multiple people. As per the patient’s rights, it is better to ask the patient to ensure the confidentiality of the patient’s medical information before sharing any confidential information. There will be multiple visitors who might act as caretakers but we need to identify and know clearly whom to communicate. Knowing the name and relationship of the caretaker with the patient helps develop essential rapport.
2. Engage the patient’s family: Family members are often essential in providing support and care for the patient. Identified family members should be involved in the patient care right from the beginning. Since they are close to the patient they will know the finer details and have a set of information useful for making the diagnosis and planning the treatment.
Involving the patient’s family in decision making by explaining the patient's condition and discussing the options for treatment is helpful in obtaining their cooperation and adherence. The family feels empowered when they are involved in decision making.
A lot of care of the patient can be managed by the family with little training and supervision. For e.g. Changing patient’s position, keeping an eye on the I/V fluid bottle, care of the back of an elderly bedridden patient, physical exercises, etc. Engaging the family in these simple activities can help them learn these under the supervision of hospital staff and prepare them for home care.
4. Address their concerns: The family members would have a lot of concerns about the patient. They may be concerned about the well-being and comfort of the patient. They may be apprehensive about the recovery and complications. They may have financial concerns and may be worried about the expenditure. It is essential to address their concerns and fears through regular communication.
They would also have a set of expectations like prompt care, quick recovery, best treatment, etc. Addressing and fine-tuning these expectations is helpful in making these expectations realistic and unburdening the doctor and healthcare team. It will also help avoid conflict and aggressive reactions to any unexpected outcomes. Keeping them in the loop by regularly updating the family of the patient’s condition is helpful in letting them know the present situation and prepare for any eventuality.
5. Prognosticate clearly: It is very important to prognosticate clearly as the family should know the seriousness of the condition and the likely outcome of the treatment. When we fail to prognosticate clearly, the family assumes the outcome of the treatment to be good and can over-react when the patient deteriorates.
While prognosticating it is important to be sensitive but straightforward as any attempt to give unrealistic hope can be counterproductive and create confusion. Answering their questions with patience and honesty will further help them take a realistic decision and build trust on the treating team. Their decision for second opinion, shifting the patient to another set up or going LAMA should not be viewed as an insult or offense.
6. Seek formal permission from the patient before sharing any information with the attendants: While sharing a patient’s information, it is best to exercise all precautions and seek formal permission from the patient before sharing the information with anyone other than the patient. It is important to ask privately to the patient so that the patient can give an honest reply.
Even while handling couples, it is best to treat them as two individuals, and information of the patient should not be shared with the partner, without seeking formal permission from the patient. Don’t assume that the other partner would know everything or should know everything. It is completely the patient’s choice whether to share the information with the partner or not.
In case of breaking bad news like complication or death, it is advisable to communicate with the family member, whom you are familiar with and have a rapport. Breaking bad news to a new or unfamiliar member can lead to aggressive and violent reactions.
Communicating with the family of the patient is one of the primary responsibilities of the healthcare providers. Effective communication with the family helps build rapport and win their trust essential for treatment compliance and better healthcare outcomes. Involving them in decision making, addressing their concerns, and keeping them in the loop by regularly updating them are some of the essential communications with the family of the patient.
Dr. Indu Arneja is a visiting faculty to some of the very prestigious organization like IIM Ahmedabad, Delhi Judicial Academy, Maulana Azad Medical College, Delhi University, IGNOU and PHFI. She has over 30 years of experience in the field of health and training.
She is a regular invitee at National and International Conferences. Recently, she was invited to attend Annual Summit on "Patient Experience and Empathy" by Cleveland Clinic, Ohio, USA, 2019. She has been awarded scholarship to attend a prestigious communication course ‘ENRICH’ organized by Academy of Healthcare Communication at Pittsburgh, USA in 2019.
She regularly conducts webinars for national and international audiences. She has conducted multiple webinars for Anschutz Medical Campus, Colorado, US.
She has a YouTube channel in her name Dr. Indu Arneja and has an on-going series under the titles - "Heart to Heart talk with Dr. Indu Arneja" and "Master Stroke with Dr. Indu Arneja".
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Great article!y
ReplyDeleteWhat you've highlighted is so important... especially about the hospitalisation being a "treatment" not just for the patient,but for the family!
The other side of the story is that the patient as well as the primary decision-maker/ care-giver, often shy away from asking questions to the surgeon/doctor. This is perhaps out of a sense of reverence or deference to the profession. However, there are doctors too, who carry their ego on their sleeves
and take offence; often being curt or showing displeasure at any direct enquiries about the details of the procedure and the possible outcomes.
Hospitalisation of a loved one is often a very stressful time and emotions do run high. Often, this episode can have huge financial implications for the patient/family. This, combined with the suspicion that hospitals these days seek to profit from this, has contributed to volatile reactions.
Great article!y
ReplyDeleteWhat you've highlighted is so important... especially about the hospitalisation being a "treatment" not just for the patient,but for the family!
The other side of the story is that the patient as well as the primary decision-maker/ care-giver, often shy away from asking questions to the surgeon/doctor. This is perhaps out of a sense of reverence or deference to the profession. However, there are doctors too, who carry their ego on their sleeves
and take offence; often being curt or showing displeasure at any direct enquiries about the details of the procedure and the possible outcomes.
Hospitalisation of a loved one is often a very stressful time and emotions do run high. Often, this episode can have huge financial implications for the patient/family. This, combined with the suspicion that hospitals these days seek to profit from this, has contributed to volatile reactions.
Thank you Mr. Anil for agreeing with my thoughts. I understand your concern for the changing healthcare. I think, with changing dynamics, healthcare is going to be responsive to varying needs of the society
ReplyDeleteYes , I do agree.To prevent the violence in the Hospital, this article is very important. All Health care Institutions can apply this solution.
ReplyDeleteJust like Missionary Institutions r maintaining healthy Atmosphere by good timely interactions and Communication. Also spiritual touch can help us.
Sangita.Nurse Administrator.
Thanks Sangita for your comments. This is a long pending change we need to bring in our approach. Patient-Centered Care is the need of the hour and is bound to happen
Deletegreat insight... thanks a lot . treatment not just of patient...
ReplyDeletebut of the entire family ������������
keep posting such wonderful articles...more power to you ����
Thank you so much for your appreciation. I really wish we understand the importance of comprehensive Communication with Patients and their families.
DeleteI am encouraged to post more such articles. Thanks for your kind words!