Communication with Family Members
- Essential for Good Patient Care
When should you call family members and what should you tell them?
If you take care of children under 18 or people over 65 and frequently for those in between as well, you will need to communicate with family members who wish to be involved and to be kept informed. Usually the patient wishes for this to happen as well, although occasionally you run into the situation where the patient does not want particular individuals in the family to know anything about his/her diagnoses or treatment. You should respect these wishes unless the person is underage or mentally incompetent. The HIPAA laws require it.
However, most of the time you will be talking with family members, especially those of patients who are seriously ill and/or hospitalized. They of course want to know how the patient is doing, what the diagnoses and prognoses are and how best to handle situations that may come up at home.
When to call a patient’s family is a matter of judgment. You probably don’t need to call if the patient comes to see you for a minor ailment unless they previously have indicated that they want to know about everything that happens. If you find a serious problem, however, you should ask the patient if s/he wants you to call a family member. Depending on what you know about the patient and family, you may even want to call them first before you tell the patient so they can be there for him/her at the time.
Often, health professionals feel a little freer to discuss prognosis with the family than they do with patients although perhaps that should not be the case. It is nevertheless easier to let the family know what to expect than the patient in the case of a life-threatening illness. It is important for both the patient and family to know the score, but you may discuss it in more specific terms with the family than you would with the patient.
Most families are very grateful for your communication with them. Others expect it and become very upset if you don’t initiate a dialogue with them. I have had situations where I have admitted perfectly competent patients to the hospital with routine illnesses (non-life-threatening) and received a berating from the spouse 2 days later because I hadn’t called to give information, even when I have left a phone number with the patient for the family to call if they wish.
As a result of these experiences, I think it’s wise to ask the patient if it’s okay with them to call the family and let them know what’s going on and then follow through with it. If the family wishes, and especially in the care of a mentally incompetent or very ill patient, you may want to call the family after every visit. Always call if the patient’s condition changes in any way. There’s a quotation I remember from Mark Twain indicating (paraphrasing), “You should always do more than what’s required. You will satisfy some and amaze the rest.”
Always return phone calls from family members as soon as you can. Never ignore them. They are an important part of the health care team taking care of the patient. The families are already under stress with their loved one being ill. If you do not discuss things with them, there will be at minimum, frustration, if not outright anger, which will only make your care of the patient more difficult and uncomfortable for you and for them in the long run.
There is an excellent position paper from the American College of Physicians entitled Family Caregivers, Patients and Physicians: Ethical Guidance to Optimize Relationships, which may be helpful to you on this subject.
I have often found that the gratitude received from families with whom I have communicated well throughout a patient’s illness is one of the greatest rewards I receive as a physician. Pay attention to them. Make the extra effort to communicate and foster a relationship with them and they will reward you also.