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Dr. Maria Muraca |
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Dialogue Issue 4, 2016
the patient’ s experience.”
The ripple effect
Take someone who’ s off work for an extended period because of an illness or injury. Consequently, the family’ s reality has changed. Some members of the household have had to assume caregiving tasks. The patient is feeling a diminished role within the family unit. Tension is high. Finances are tight. The supportive environment is shaky. And all of this is affecting the patient’ s recovery.“ There’ s a tremendous ripple effect,” says Dr. Brown, a social worker by training, and Chair of the Masters of Clinical Science and PhD Programs in Family Medicine at Western. That’ s why it’ s important, she says, for doctors to tease out how( or if) family is being an impediment or a buoy. She defines family as two or more persons sharing a community and support system. When talking to patients, doctors can pose all sorts of relevant questions. How’ s it going at home? Who are you turning to during this challenging time? How are other members of the family coping? How is this affecting your daily routine and responsibilities at home?“ You ask open-ended questions that are non-judgmental and that also show compassion
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,” says Dr. Brown, co-editor of a book called Challenges and Solutions: Narratives of Patient-Centered Care. Such probing accomplishes a few things. For one, it can boost patient satisfaction and hard outcomes.“ Giving the patient permission to share may be therapeutic in itself,” says Dr. Brown.“ When a patient feels attentive listening, that can be beneficial in healing. You don’ t have to do anything; sometimes you just have to be there.” Dr. Muraca, who’ s also an Assistant Professor, Family and Community Medicine, University of Toronto, talks about giving patients the“ safety zone” to discuss the intertwining of family and health. In learning more about the variables at home – things that can influence the patient’ s health, recovery and mental state – the doctor can offer helpful advice or make referrals to other forms of support. Another option is asking the patient if he or she wants to invite family members to talk about the issues at hand.
Understanding stressors
Routinely, of course, doctors deal with the opposite situation, serving patients who are affected by health care issues or other events in the home.“ A lot of what we see is influenced by the psychosocial component, the stressors going on in someone’ s life,” says Dr. Muraca. One of her colleagues on the North York Family Health Team, Dr. Marla Ash, cites a patient whose spouse was quite ill. The patient revealed the increasing pressure at home, not only because of the disease but because of how each of them was handling it. Their sources of comfort differed, and they weren’ t fully connecting with each
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photo: arash moallemi |