Communicating With The Family of the Patient by Dr. Indu Arneja

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.

3.    Empathize with the caretakers:  When a member of a family falls sick, it is the family who faces the brunt of the situation.  Looking after the patient while performing all other daily responsibilities can be quite exhausting for the family.  With no proper place to sit, relax, eat, or sleep in the hospital, family members are literally lying in the corridor or vacant places in the hospital.  Family members are usually under tremendous stress and expect us to be kind and nice to them.  It is important to be aware of their challenges and being more empathetic towards them.
 
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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When Patients Charge You of Over-Charging

Dr. Indu Arneja is Founder Director of Indian Institute of Healthcare Communication, A pioneer in the field of Healthcare Communication in India

She has conducted around 1500 Clinical Communication programs for doctors, nurses and other healthcare professionals in more than 100 hospitals and medical colleges across the country.

She is an external assessor for NQAS, Ministry of Health and Family Welfare and NABH (IRCA), QCI, India

She is a core group member of Advisory Board on Health and Mental Health for Nation Human Rights Commission. 

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".

In this article, Dr. Indu Arneja shares simple and easy to follow strategies to avoid disputes with patients on account of the billing process. 

There will be times when in spite of keeping your charges very reasonable your patient may blame you for overcharging, especially during the COVID19 pandemic situation.  There is no doubt that you cannot please everyone but the following guidelines can help you manage the situation amicably:

1.          Keep your charges reasonable and comparable with the practitioners working in your area of practice (geographical area), unless you are a very renowned practitioner or surgeon and people come to you for your name and fame.

2.          Keep your billing very transparent and comparable to avoid any conflict – provide itemised billing to your patients.

3.           At the time of admission itself, have a printed estimate ready for the procedure / surgery which should include the cost of both consumables and non-consumables including cost of materials, drugs and other consumables. This should include the room charges, nursing charges, OT charges, Anaesthetist charges (in case an Anaesthetist is involved), and any other charges that you think adds to the expenditure.  Do not just hand over the copy of the estimate.  If the patient needs to understand, please have someone do so. This is anyway mandatory for Accredited Healthcare providers. 

4.           Asking patients to deposit a huge sum of money at the time of admission, irks patients.  Tell them how the treatment will progress and that the next two or three installments will have to be paid on day two.  Most patients will not resist paying small amounts upfront and arrange to pay as the treatment progresses.  Don’t show a cold face that you don’t care whether the patient can pay or not or they can take the patient away kind of attitude.  It doesn’t help anybody in that situation.  This is in effect, the “Moment of Truth” and is also an opportunity to build good relations with your patients.

5.           Do not have any superfluous charges in the estimate. It may irk the patient and create conflict.

6.           Explain this break up with complete patience in a professional manner.  Provide detailed break-up and why specific item(s) have been included and how it was used as a part of the treatment process.

7.           Follow the similar process, if you have to give a daily bill summary.  This will avoid the dispute at the time of final billing.

8.          If possible, have an experienced person like a counselor or a nurse to explain the cost and expenditure. They can work as an interface between you and the patient.  In this scenario, there is always an opportunity for the Nurse or Counselor to escalate this to the next senior level.  The patient also feels having his/her issue being redressed at a higher level.

9.          Maintain a professional distance with your patients to not allow the patient /relative to misbehave with you.  Professional distance does not mean being rude but it is being respectful and firm.

10.       In the want of admission or surgery do not try to be extra-polite and extra-nice to the patient. The patient may think you are desperate and act pricey.

11.       Staying calm and maintain composure while explaining the estimate can help you win patient’s mentally.

12.       Never discuss or argue in an open space, as the presence of others can complicate your interaction.  The patient/relative may seek extra attention and public support.

13.       There will usually be an attendant with the patient, who may be aligning and agreeing with you. Involve that person to handle the situation.

14.       There is no harm in knowing what others are charging for the same procedure.  Without quoting any one’s name you can mention the regular price in the market.

15.       If you are really good at humor, bring in some good examples to support your point. For e.g. when you buy a cup of coffee at CCD, you not only pay for the coffee but for the ambience, facilities and services. Please use these examples, if you are really good at handling people otherwise this can backfire and escalate the argument.

16.       In case the patient misbehaves, never get into an argument or unnecessary explanation. This is further going to escalate and leave you feeling hurt and insulted.

17.       Have a good rapport with your fellow professionals. In case the patient goes to them and talks ill about you, they should resist professional jousting and stay professional.

18.       It is better to lose such patients than keeping them with you and listening to their music. It is not advisable to work under any kind of pressure. You will not be able to give your best.

19.       It is important to value your brand for a long haul rather than get into fist-fights with patients and ruin your brand that you have built so lovingly over the year.  Every colleague and employee of yours must have the same strategy to deal with patients.  An error by any employee can affect your brand value. 

20.       It is important to have a diary or log of disputes with patients and their concerns.  This will help you to identify the most common issues and will enable you to come up with effective strategies to ensure that they are not created in the first place.

She may be contacted on - arnejaindu@gmail.com

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