Views And Reviews Acute Perspective

David Oliver: How much information should patients’ families expect on acute wards?

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4295 (Published 11 October 2017) Cite this as: BMJ 2017;359:j4295

Communicating with relatives is a double-edged sword...Re: David Oliver: How much information should patients’ families expect on acute wards?

Thank you David Oliver for being that person who stands up to say openly what so many are only willing or confident to say behind closed doors.

I remember many evenings and weekends on call as a junior doctor being accosted by eager relatives wanting to know exactly what happened, when, why, and what happens next. Or paged by nurses saying Mrs Z's 3rd cousin has just arrived from Australia and wants to know what's happening. With 20 jobs to do and half a hospital to look after, faced with trying to decipher and then translate the notes of a patient I have never met to ease the guilt-driven anxiety of a prodigal relative, cognitive overload kicks in.

Cold common sense says there is no urgency, I am not the right person to have this conversation, this could be a breach of confidentiality. But inexperience, stress, tiredness, and youthful eagerness to soothe anxious relatives' need for reassurance, leaves young doctors vulnerable. With experience I have come to realise that such conversations with distanced relatives are unnecessary, even harmful. With practice and confidence I can defer to the patient, close relatives/carers, nurses who know what is happening.

There are so many things wrong with the above scenario- work over-load, inappropriate task delegation and bullying, professional self-derogation (why make the FY1 do what the nurse is better placed to do?), and lack of leadership to prepare and support staff for recurrent events. And all this does is perpetuate the unrealistic expectations for endless repeats of information, and denegration of the nursing profession

But on the other hand, relatives deserve compassion, understanding. There is (in most cases) no intent to add to the doctor's stress, or put them on the spot. They just want to know what's happening, what does it mean. What is needed is clear information on the wards to indicate how to get information and duties of confidentiality; nursing staff actively encouraged to use the voices they have as patient advocates and healthcare professionals; and leadership to direct and promote staff support, clear boundaries and realistic expectations.

Communicating with patients is a double-edged sword, but compassion and realism can cut through the suffering of both anxious relatives and tired, stressed doctors.

Competing interests: No competing interests

12 October 2017
Cathy Welch
GP
Arran Medical Group