Although physicians are urged to communicate one-on-one with patients, they may instead find themselves involved in conversations with three, four or five people at a time.

That’s because when doctors treat patients—either in their office or at a hospital—they frequently must also deal with concerned spouses, partners, family members and friends.

Whether dealing with a disabled elderly patient’s anxious adult child or the good friend of a phobic patient, physicians must interact effectively with everyone in the room and focus attention on one goal: the patient’s well-being.

Tips for forging a good relationship
Some fundamental recommendations that apply to a physician’s communication efforts with patients are also relevant when dealing with patients’ support networks. For instance, keep explanations and definitions simple, no matter whom you’re talking to (e.g., say “bruise” instead of “hematoma”). If a patient has a chronic condition that requires careful management, consider encouraging the patient and concerned loved ones to supplement the knowledge and assistance you provide by reading books and articles or by joining a support group.

Aside from these recommendations, there are several specific strategies that can facilitate communication and cooperation between physicians and members of support networks, which should result in improved patient care. Based on advice in the book “Communicating with Today’s Patient” by Joanne Desmond and Lanny R. Copeland MD, here are three tips for establishing a good working relationship with patients’ family members and special friends:

Acknowledge the other people.
At the beginning of the visit, ask a patient’s companions their names and relationships to the patient. Assume that their presence is important to the patient, and refrain from rushing the introductions: Take your time, make eye contact and be conscious of body language. Also, make a note of the information you garner, and greet these individuals each time they return with the patient.

A simple act such as this shows respect and understanding, and helps set the stage for a cooperative effort. Patients depend on family and friends for support—emotionally and, in some cases, physically—so the physician’s apparent desire to include them will be appreciated.

Solicit their help.
Assign willing loved ones small roles in patient care. They will likely welcome the opportunity to pitch in, and their participation may have a powerfully positive impact on patient compliance.

Contributions you might ask them to make include monitoring and administering medications, encouraging and overseeing a diet-and-exercise program, and scheduling and providing transportation to appointments. Of course, the family member or friend must be capable of fulfilling such roles; they should never be encouraged to take on responsibilities that are more suitable for a trained healthcare professional.

Thank them for their help.
Caregivers are susceptible to burnout: Loved ones who agree to lend a helping hand may eventually feel that they’re giving an arm and a leg! Their sense of responsibility may lead to worry, stress, strain and, eventually, exhaustion.

That’s why it is important for the physician to recognize and reinforce the caregiver’s role. However minor the task performed, stress to the caregiver that it is important both to the patient and to you. A simple acknowledgment from time to time can help refocus a caregiver’s efforts and refuel his or her energy.

When three’s a crowd
Sometimes people with difficult personalities can stand in the way of building a constructive relationship with patients. For example, some spouses, relatives and friends may tend to assume control of appointments and put words in a patient’s mouth.

Even if the companions are passive onlookers, their very presence may keep the patient from discussing embarrassing symptoms freely or answering intimate questions honestly. If a physician thinks— for whatever reason—that a patient’s companion is compromising communication, it may be necessary to tactfully ask to be left alone with the patient.

If this is the case, experts recommend the following approach:

• State the benefit to the patient — “Ms. Green, your father needs a thorough examination so we can figure out what’s wrong and begin treatment immediately.”
• Say what you want or need — “I’m going to ask you to wait outside during the examination.”
• Validate the companion — “It is very important, however, that you join us again after the examination so we can discuss our options.”

Conclusion
Maintaining a good relationship with a patient’s personal support network can be enormously helpful in gaining compliance and achieving a positive outcome. It may also be a factor in keeping physicians out of court in the event of less-than-ideal outcomes.

Of course, no relationship is perfect; when there is friction, it’s important to deal with it. Interacting with the important people in a patient’s life requires some effort and, at times, patience. But the payoff in terms of overall care and patient satisfaction is inestimable.