Am Fam Physician. 2016 Mar 1;93(5):388-391.
A 75-year-old man with newly diagnosed advanced cancer was admitted to the hospital for a four-week duration. His prognosis was uncertain. The patient had six children, three of whom were always by his bedside, along with his wife. As the patient's condition worsened, his three other children joined them. All three were practicing physicians. One was a family physician, one an oncologist, and another a palliative care specialist.
Initially, the attending physician and clinical team actively managed the patient's condition. During the first two weeks, the attending physician would speak with any of the physician children present, but as the prognosis worsened, she began communicating directly with the son who was the palliative care physician, whom the family had designated as their spokesman. Although the clinical team presented an optimistic outlook to everyone during family meetings, they were more realistic when speaking privately with the palliative care physician.
After two weeks, when it became clear that the patient would not recover, the clinical team began placing the burden of breaking bad news on the palliative care physician family member who was acting as the primary decision maker. Although family meetings continued, the clinical team assumed that the son would provide the palliative care, and they did not schedule a palliative care consultation or discuss palliative care with the family. How can attending physicians and staff best interact with physician family members, and how should their roles have been handled in this case?
It is not unusual for physicians to care for patients who have physician family members. This can be advantageous for patients, their families, and the clinical team because physician family members often better understand the clinical situation, its severity, and the treatment options. They can also assist the clinical team in educating the patient and other family members. However, the presence of a physician family member can also become a barrier to the delivery of care.1 A physician family member may let personal stress and emotional conflicts get in the way of rational care. The need for control may lead the physician family member to overstep boundaries and affect clinical decisions by redirecting care,2 which may cause increased anxiety among the clinical team.
At the same time, the family may have unrealistic expectations of the physician family member, calling on him or her to direct the clinical team. Concomitantly, the clinical team may also have unrealistic expectations of the physician family member, for example, expecting the person to break bad news or deliver support to the rest of the family, even though his or her objectivity may be compromised. To ensure everyone's needs are met, ground rules outlining roles, responsibilities, and expectations need to be established by the clinical team and the family up front and an open channel of communication created.3
ESTABLISHING GROUND RULES
The first step in interacting with a family where a physician family member is involved is to discuss the roles of the different parties as soon as possible. In the case described here, communication was better while the patient was stable; however, when the patient's status deter
REFERENCESshow all references
1. Fromme EK, Farber NJ, Babbott SF, Pickett ME, Beasley BW. What do you do when your loved one is ill? The line between physician and family member [published correction appears in Ann Intern Med. 2009;150(4):291–292]. Ann Intern Med. 2008;149(11):825–831....
2. Young M. When medical professionals get involved with a family member's care. Physicians Pract. July 14, 2014. http://www.physicianspractice.com/blog/when-medical-professionals-get-involved-family-members-care. Accessed September 14, 2015.
3. Chen FM, Feudtner C, Rhodes LA, Green LA. Role conflicts of physicians and their family members: rules but no rulebook. West J Med. 2001;175(4):236–239.
4. Arnold RM. Fast facts and concepts #131. The physician as family member. http://www.mcw.edu/FileLibrary/User/jrehm/fastfactpdfs/Concept131.pdf. Accessed September 14, 2015.
5. Fromme E, Billings JA. Care of the dying doctor: on the other end of the stethoscope. JAMA. 2003;290(15):2048–2055.
Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to firstname.lastname@example.org. Materials are edited to retain confidentiality.
This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.
A collection of Curbside Consultation published in AFP is available at http://www.aafp.org/afp/curbside.
Please send scenarios to Caroline Wellbery, MD, at email@example.com. Materials are edited to retain confidentiality.
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