practice partner
How to work with
a difficult family
member
DOC TALK
By Carol Hilton
illustration: sandy nichols
D
r. Louis Kennedy had been in practice for
about three decades when he faced the
toughest encounter with a patient’s family
member of his career.
As a family physician and hospitalist in Kingston,
Ont., Dr. Kennedy was caring for Peter*, an elderly
patient with advanced dementia. Although Peter was
completely disoriented and doubly incontinent, the
most challenging aspect of his care was the man’s
daughter, Elise.
“It was all about her – she knew more than the nurses,
more about the medications,” Dr. Kennedy recalls.
“It wasn’t at all about her father. And what really hurt
me was that she was mostly giving a hard time to the
nurses, verbally abusing them, creating controversy,
making threats.”
Luckily, Dr. Kennedy recognized that despite physicians’ innate desire to solve problems, he wasn’t going
to be able to “fix” Elise’s behaviour, and he approached
Peter’s wife to open a new channel of discussion. He
also embarked on a path toward improving his com-
munication skills to handle such situations through
continuing education.
You’re not going to get away from ‘difficult’ patients
and ‘difficult’ family encounters; it’s part of the work we
do, says Dr. Doug Oliver a family physician and an associate professor in the department of family medicine
at McMaster University.
But Dr. Oliver said there are some strategies that
physicians can use to turn the relative’s energy around
– from hindering your care to actually helping support
the care you provide.
Making this effort of getting family members on
board with a treatment plan could be a big win for all
concerned. In our recently approved policy, Planning
for and Providing Quality End-of-Life Care policy,
we make the point that involving family in the decisions around the patient’s ongoing care can be the best
approach.
“Involving family and/or others close to the patient in
the ongoing care of a patient may be beneficial as it can,
for example, help the patient understand their diagno-
*Names have been changed to protect the patient’s anonymity.
Issue 3, 2015 Dialogue
39