Unhealthy family dynamics in the exam room: how to respond

Family members can be important partners in a patient’s care, but they can also complicate patient visits at times. When you see signs of unhealthy family dynamics, here’s how to identify what’s really going on so you can respond appropriately:

1. Did the family have a negative health care experience in the past? For example, maybe a member of the family experienced a medical error, a tragic hospital stay, or just a rude nurse or physician. If so, they may need more explanations and reassurances from you in order to build trust.

2. Is the family undergoing a major life event? Events such as the death of a spouse or a parent’s Alzheimer’s disease diagnosis can cause intense stress and irritability. Being aware of major family events will help you to better empathize with and care for the patient and family.

3. Are the family members in conflict with one another? When a patient or family member has an intense or angry reaction that doesn’t match the circumstance, consider whether conflicts within the family are spilling over into the office visit. Avoid triangulation by staying neutral and professional.

4. Does the family have uncommon medical beliefs? For example, if a family believes that you don’t see a physician unless you are on your deathbed, or that illness is God’s way of punishing people, such beliefs can color the interaction. You can respond by respecting the family’ beliefs while encouraging the patient to follow medical recommendations that are in his or her best interest.

5. Is there a “health expert” in the family? Almost every family has someone who plays a vital role in the family’s health habits and behaviors, even though this person may not have any formal medical education. This is the person you likely need to influence.

Read the full FPM article: “Managing Family Dynamics.”