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A common problem leading to lawsuits against medical doctors is the breakdown in communication between physicians and their patients’ family members. This can be especially important with the families of elderly patients. When caring for the elderly, you’re not just dealing with the individual patient, you’re dealing with the collective family unit. The following are key to improving your communication skills when dealing with your patients’ family members:
- Focus not only on the words you use, but also on nonverbal cues such as the volume, pace and pitch of your speech. Modify your level of eye contact with family members if they are emotionally fragile, physically smaller than you or sitting while you are standing.
- When family members are speaking, do not interrupt them or complete their thoughts. Listen, process, then respond.
- Once you’ve listened, answer in a gentle way that communicates compassion, kindness and patience. Healthcare providers may assume that demonstrating a caring attitude takes a great deal of extra time, but in reality it can happen even within severe time constraints. The key to having caring interactions with family members is to treat them with respect, which can be expressed in a variety of ways:
- Ask relatives how they would like to be addressed, i.e., Mr., Miss, Ms., Mrs. or by first name.
- Always use a polite, deferential tone.
- Stay focused on the family members; don’t let your mind wander while talking with them.
- Maintain eye contact when speaking; don’t talk as you walk out the door.
Helping a Family Cope
In general, physicians are expected to communicate honestly and directly on matters of clinical significance. For patients suffering from Alzheimers and other dementias, however, such straightforward communication may not always be appropriate.
One of the biggest dilemmas physicians face is when family members ask them to withhold a diagnosis from the loved one. Frequently, patients are in conflict with their family members over this and other issues. It’s important that physicians build on their ties with a patient’s family during these difficult times, because ultimately the family will likely be needed to provide care and make future decisions.
When a physician shifts from giving curative care to providing palliative measures, it is an acknowledgment that managing pain and improving quality of life are the most appropriate and realistic goals under the circumstances. This change in focus can be difficult for family members to acknowledge and accept.
With good communication, however, physicians can make an enormous difference in helping families cope with the reality of the situation.
Open communication between physicians and family members should be an integral component of end-of -life care and the process of grieving. Virginia P. Johnson MD and Carol Christianson MS, authors of The Grief Process: Implications and Interventions for Professionals, recommend the following to help a family whose loved one is dying:
- Explain the patient’s diagnosis, prognosis and life expectancy. Describe the nature of the grieving process and any physical symptoms or feelings associated with it.
- Acknowledge how you have dealt with grief in your past. Don’t say “I know how you feel” unless you are willing to share your own experiences.
- Find out about any past losses the family has suffered and how they have dealt with grief.
- Research how different cultures grieve so that you can support a particular family in a culturally appropriate way.
- If the family needs explicit instructions on how to care for the patient—especially in the latter stages of the illness—take the time to write them down, as well as appointments, medication dosages and important phone numbers.
- Suggest that the family make a list of people who will help out, plus a list of necessary chores—for example, cooking a meal, doing laundry, cleaning the house— for when someone offers to assist.
- Provide the family with information about support groups and grief counseling.
Preparing for Death
Death has long been regarded as tantamount to medical failure—a view that implies doctors have nothing to offer a dying patient and his or her family. Physicians must recognize that quite the contrary is true. Good communication can help allay fears, minimize pain and suffering— both emotional and physical—and enable patients and their families to experience as peaceful a dying process as possible.
Death is never an easy subject to deal with, but there are many support options, such as hospices, bereavement groups and counseling. End-of-life care can be enhanced, and the trauma of losing a family member significantly alleviated, with adequate preparation for the patient’s death and follow-up with the family afterwards.
No physician is immune from medical malpractice lawsuits, but developing excellent relationships with patients’ family members— especially relatives of elderly patients—through good communication can go a long way toward reducing a physician’s liability risks.
Caring for Nursing Home Patients: Family Complaints a Red Flag
When physicians take care of elderly patients in nursing homes, their liability risks can rise significantly.
Nursing home patients’ relatives—especially those given to complaining—are by far the most common source for the initiation of medmal lawsuits. Complaints from relatives should raise a red flag that, for whatever reason, this is an angry family.
Most complaints result from misunderstandings and can be easily resolved. If a physician is unwilling to communicate with family members—or just gives that impression—the family may conclude the doctor is trying to hide something. Maintain good communications with families by answering telephone calls, e-mails and letters promptly, and by being otherwise accessible.
Whenever an adverse event, no matter how minor, occurs, give instructions for its management and for preventive measures to avoid similar incidents in the future. For example, a patient may suffer a fall that causes no injury and is considered trivial. If the next fall causes a broken hip, it could result in a lawsuit; the physician may be named because he or she did not write a note documenting the initial incident or any preventive measures.
Sometimes ancillary services such as physical therapy, occupational therapy and speech therapy are indicated but are denied by Medicare or the patient’s private insurance. If that happens, be sure to document the reason for the denial; don’t make it appear as if the nursing home is simply trying to save money.
Indeed, physicians should always maintain good documentation, because their primary defense in any lawsuit is what they’ve written in the patient’s chart. A plaintiff’s attorney may blow trivial incidents out of proportion in an attempt to show a general pattern of poor care, and if the documentation from the physician is inadequate, it can seriously weaken his or her defense.
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