"His niece is a family practice doc."
"His son is a cardiologist."
"His daughter is a nurse."
I often wonder, what am I supposed to do with that information? Am I being warned to expect a grilling? Am I being warned that every action by me will be questioned? Am I being warned that they will expect the red phone lines of communication? Often times, I wonder what goes through the minds of the medical family when their loved ones are admitted. Do they have unmanaged expectations?
Most families, I'm sure, fire up their internet as soon as their garage door opens and the MacDonald's wrappers are ditched, searching for anything they can to play Google doctor. But, I think it's unlikely that the nurse, family practice doc or the cardiologist will be surfing "Making the most of your atrial fibrillation". It's unlikely that they will be home reading "Diabetes is your best friend". It's a unlikely they will find the web site titled "How to beat coronary disease without really trying". Their knowledge base is vastly superior to the general public. They have confidence in their understanding of nana's illness.
Sometimes I get involved with less intensely trained, but never the less, just as dangerous medical oriented families. Those that know much less than they think they do. These are the tough ones. The ones that can't seem to understand why pappy ain't' getting better. Like the general public, they often simplify things into black and white categories. If you do X, the result will be Y. And all will be hunky dory. It just doesn't work like that. If you do X, you can get, L,O,T,S,O,F,T,H,I,N,G,S.
Sometimes I'm surprised, incredibly surprised, even by doctor families that are so blinded of the reality, they can't see the forest from the trees. The patients who are clearly so ill, that aggressive intervention is the worst possible course of action. Examples would include hemocult positive stool in a 95 year old whos gastroenterologist son requests a GI consult for endoscopy. Or how about the elevated blood sugar of 180 in a severely demented nursing home patient, whos endocrinologist daughter requests more aggressive treatment. Or how about the 99 year old patient with a non ST elevation MI whos cardiologist son requests a cardiology consultation for evaluation for heart catheterization.
Doctors and nurses, I have learned, are not immune to unmanaged expectations. We can be blinded, just like the general public, into seeing what you want to see, and losing your sense of reality.
When I discuss treatment options and plans with medical oriented families my jargon is much more technical, because that is how we communicate. That is how doctors understand each other. They don't get the red phone from me. As they are busy, so am I. My time with their grandma is no more important than explaining to the janitor's wife why her husband needs to be on insulin when he goes home. I just use different language.
So docs, how do you handle the demands of medical relatives who try to drive from the back seat?
photo credit
18 Outbursts:
So docs, how do you handle the demands of medical relatives who try to drive from the back seat?
also Or how about the elevated blood sugar of 180 in a severely demented nursing home patient, whos endocrinologist daughter requests more aggressive treatment.
I cut my losses. This is from an outpatient, IM perspective, and I had the exact thing above happen, but there wasn't an endocrinologist daughter; rather, one of the nagging home health agencies that are always trying to get my business, went into the home and convinced the daughter that 82 y.o. Mom (who is a retired nurse thirty years ago, with multi-infarct dementia) needed an Endocrinology consult, whose MMSE score is 23.
I refused to sign off on the orders (that comes weeks after treatment), after discussing the egregious case of malpractice (yes, malpractice) sold to the family by the HHealth representative. She had previously been seeing me, with the daughter, about every 10 days. I had been building a case of "safety is not represented by letting Mom stay at home and manage her own BG of 400." HHealth was supposed to give me values only, bid. Instead, they entirely undermined the PPR and now 82 y.o. Mamma is get fitted for an insulin pump as the next step from her 2.5 mg of glipizide. For layman, this is not how you treat Type 2 Diabetes, where medical compliance, supervision, and oral medicines could give Mamma another 6-12 months at home while you get your shit together.
My point is illustrative of yours: Our liberal society even has HCW's and their families undermining the patient's interest in the sickening credo that equality (even of opinion) is of more value than Truth and Knowledge.
I usually state at the beginning that I know they are medically trained, but I will be treating them the same as when I treat "regular" people.
Here's why: When I had my stroke, a lot of docs used very technical language with me.
First of all, I was brain damaged and even if I remembered neuro from MS-2 or internship before the stroke, it's gone now. Secondly, I can't think like a doctor when we're talking about me. So I asked them all to treat me like anyone else and that worked a lot better.
Interestingly enough, I had a practicing FP as a patient once. I knew him professionally, and he knew me. When I went over his labs with him, he was asking me the most basic questions. "What do you want my LDL to be?" and "Why is my creatinine so high?". I talked to him just like I would anybody, and he thanked me. At the end of our conversation, he said, "I just lose all my doctorness when it's my body." Exactly.
Off topic: You take fabulous photos of your dogs. Love this one up there now.
I love the dogs, but not the patronizing attitude. I am in a medical family and having been in one, know doctors are far from infallible. I chip in with my own research and expect to be treated with respect. Not deference. But also not contempt and head pats. Why not even take time to talk to the family--or is that forbidden by HIPAA or something?
anon, I think you read something that wasn't there. I talk with doctor families, just as I do non doctor families. Where did I say I dont' treat doctor families with respect? I said I wouldn't give them any special treatment above what my non doctor families get. Some expect that. Some expect the red carpet.
I've noticed that sometimes when I get report, the departing RN's will tell me that this patient or that patient is a Nurse, occasionally that they're an MD. I wondered what to do with this information at first, and eventually I decided to use it to guide my patient teaching. There's nothing more irritating to a seasoned professional than having a young amature talk to them like they don't know what DVT prophylaxis or incentive spirometry is. I don't -exclude- this teaching, of course, I just present it as a good-natured reminder, whereas with less medically savvy patients I tend to "Start from the beginning" (albeit still good-naturedly. heh).
I'm frequently surprised, however. Once I had to explain to a doctor of dental medicine what an EEG was. The consequences of specialization, I suppose.
Obviously when it comes to patient care you should do your best for everyone regardless of whether they are related to a doctor or a janitor. However, I don't think it is unreasonable to offer some professional courtesy.
An example...My dad is a doctor. A few years ago I had surgery and spent the night in the hospital and was given a private room. Usually a healthy young person in the hospital for one night would not be given one of the few private rooms. In fact, they had me on the board for a shared room and switched me to an available private room when they realized that I was a doctor's kid.
Another example...if a physician is trying to get an appointment for themselves or a family member my dad will put extra effort into finding (or making) an earlier slot. The few days usually doesn't make a difference in terms of care (if it does he will make time regardless of who the patient is), but it does make the patient and family feel better.
Families of police officers and firefighters have decals to put on their car that are basically a "get out of jail free" pass for minor traffic infractions.
Families of those in the entertainment industry have unique opportunites to meet celebraties and attend events that are not open to the general public.
Families of retail store clerks are often given a special "family discount".
I could go on, but the point is that many occupations offer perks to family members. Why not physicians (or nurses, etc.)?
In my childhood, doctors didn't charge each other for family care. Reciprocity, they called it.
I guess I based my comment on how I was treated recently by a hospitalist when my sister was in the ICU. No one would talk to me because of HIPAA. My brother-in-law isn't "medical" and could not or would not remember things to tell us. My brother, like my father, a physician, got some info but they would not talk to him either. I went to the hospital everyday to get some info and see for myself. Even my sister's primary--who has been my primary for 5 yrs--would not talk to me. Who is HIPAA protecting? A hospitalist's time...who? or what?
I wasn't asking for some red carpet but do you people have any appreciation of what relatives go through trying to deal with you?
Anon. That doesn't make sense. Unless the patient or poa directed docs not to talk to anyone else. As far as talking to family, there should be one point of contact to whom the physician can talk to daily. Imagine if all 15 patient's families each had three or four members who wanted a daily update. That's 60 phone calls a day. Impossible. Maybe that's why nobody would update other family members. When I start to see a trend of abuse of my time by a family, I make clear what my positition is. I'll update family once a day unless something has changed clinically.
Well, when you are talking to that one designated person, you have no idea if others are getting information. And it's darned inconvenient and even dangerous--because family members may know things about the patient that you don't or that the one person will not mention (in our case, drug addiction). Just keep this in mind, is all I am saying. I doubt all 15 of your patients would have 3-4 people. I think HIPAA is just a good excuse to stay away from worried fam members, medical or otherwise. They are so needy, you know.
if multiple family members wish to speak with the doc, they should all congregate in the room when the doctor is present. If some are out of town, that contact person should relay all information. It's not ok to expect the doc to relay the same information to multiple family members on the same day.
Well, maybe it should be--on a case by case basis. Not everyone can congregate when you need them to. Just remember me the next time you answer a call (if you do) and say, "I am dealing only with her husband. Ask him." Or wife, etc. My doctor brother was in another city--he could not congregate. My other bro--no congregating possible, 2000 miles away. The designated person could not or chose not to remember my sister's status. So...I was the one.Went everyday and tried to suss it out for all of us. I have my own health issues, have to hire drivers, and might not otherwise have hauled over there everyday. My sister did not recognize us. So maybe think of this post sometimes? The patient may not be the only one who could use help.
I want to weigh in on the question of updating families regarding patient's conditions. I am an oncologist and as you might imagine discussing the condition of inpatients with new cancer diagnosis is a large part of what I do in the hospital. It is completely unreasonable for a family to expect me to hold 3-4 seperate conversations reagrding their family memeber. As Happy said, multiply that 3-4 conversations by the number of inpatients I see daily and suddenly my whole day is spent talking to family members and not actually taking care of patients. Oh, by the way I also have 20-25 outpatients to see and discuss their cancer. The other expectation that drives me crazy is that I will be available when the family wants me - often only giving me a narrow window of time. I usually will schedule family meetings with everyone present at a specified time. It really helps the communication and effiency to do this all at once. I understand that to families, the only person that matters is their loved one. However, I have to consider all of my patients and excess time talking to 3-4 family memebers at different times takes away from their care. I usually lay these ground rules down early on so that expectations are managed.
Scheduling a meeting might have helped in our situation. Waiting for you to come by would not have. Your suggestion is a thoughtful one. Od course, in the case of our uncommunicative designated person, finding out when the meeting was might have been a problem. One ICU nurse was helpful. And as I said, the doctor did speak to my doctor brother once, then no more.
family meetings are great. All parties. One time, one place. Absolutely.
I always seem to have the most trouble dealing with nurses. As an emergency veterinarin, the pets who come in with RNs as owners are more likely to do without adequate care...seems like most nurses just don't want to accept the fact that their pets are better off getting care from someone who is trained to DOCTOR that particular species, that someone who is trained to NURSE a completely different one. Maybe they don't understand the concept of species variation, and are lead to believe that the way that they have been taught to deal with similar issues in people will work for their pets. I always try to remember when I am (or a member of my family is) ill....the physician may not do things the way that I would do them, but that doesn't mean he/she is wrong....humans are just different :-)
You say sure, great, family meetings, Dr Happy. But how do you go about arranging them?
anon 1101. The nurse or social worker arranges it. I show up.