practice partner
ses, prognoses, medications, the tests that are required,
and the decisions they have to make about treatment
options. Such involvement can also help the family
caregivers to provide more effective care at home and
mitigate their own distress,” states the policy.
Below we discuss strategies for helping families feel
more involved in their loved one’s care.
Listen
In his work at a nursing home in Hamilton, Dr. Oliver
encounters many families with specific requests or
demands concerning their loved one’s care. He says he
starts off by reminding himself the request is coming
from a good place – it’s often a daughter or son who
wants to do what’s best for their parent – even if the test
or treatment is not indicated.
“Family members are going to get upset 100% of the
time if they are not being heard. I think that’s the least
we can do,” says Dr. Oliver. By listening, you find out
what the family hopes will result from whatever intervention they are requesting. “Once you’ve had a chance
to sit back and be quiet and listen, you then know
where to start the conversation. A lot of docs will get
into trouble when they start the conversation by being
dismissive or not taking the time to hear what the issues
are from this other person’s perspective.”
Dr. Oliver, who works under a capitated model, says
he will often schedule a longer than usual appointment when he knows a situation is “hot,” or he will ask
the family to reschedule so they can take time to write
down their questions and have a longer appointment
in which to discuss them. He says it can be challenging
to take the extra time to sit and chat with the family,
but in the end having this understanding “will save you
hours of problems and complaints and concerns and
headaches down the road, and ultimately result in better
care for the patient.”
What you say
After a patient’s family has had the chance to speak,
don’t immediately start offering treatment options, says
Dr. Oliver. Instead, it can be helpful to restate the family’s concerns to demonstrate that they have been heard
and you understand their concerns.
The vocabulary you choose also affects the message
you convey. In the workshops Dr. Kennedy has attended to strengthen his arsenal of communication
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Dialogue Issue 3, 2015
strategies, he says it was fascinating to pay attention to
the use of what can be considered “negative” phrasing,
such as the words “however” and “no,” that tend to cut
off discussion.
“When we did role playing, everyone kind of laughed
the third time I used the word ‘but,’ ” says Dr. Kennedy.
“And I thought, ‘Wow, it’s really hard for me not to use
that word.’ Conversation is so spontaneous. I spend a
lot of my day talking and listening and trying to communicate, and it’s hard but I’m getting better at it.”
Work with the fami