The Best You Can Do
Despite the care team’s best efforts, there will be a few cases, admits Dr. Bennett, where “you just can’t make much headway.” She recalls the case of an elderly man who had had a massive stroke, lived in a nursing home, and had not communicated for years. The man’s daughter was convinced, however, that he communicated with her and was “adamant that everything had to be done. We tried and tried,” explains Dr. Bennett, calling several group meetings and using hospital chaplains as allies, “but she just couldn’t hear it, and couldn’t see it [that her father would not get better]. She was too vested in believing that he did, in fact, communicate with her and that he would get better.”
In such cases the team may have to do the best they can to honor the patient’s and the family member’s value system and help them abide by that.
“There’s one other thing about difficult families and difficult patients: You have such an intense relationship with them that you don’t have with other people,” notes Hawgood. “If you can hang in there, they’re the best relationships you can have. You are so emotionally engaged in trying to make it work. I have chosen to work with hospitalists because of the approach they take. I think it’s the most efficient model you can use in a hospital. We really talk about the goals of care, and what we understand about the patient’s and family’s goals of care. We approach this from the point of view that they deserve care. What can we do to make a difference, so that it works for the patient and the families?” TH
Writer Gretchen Henkel lives in California.
- “Number of U.S. Medical Schools Teaching Selected Topics 2003-2004.” Compiled by the American Association of Medical Colleges Institutional Profile System. Available online at: http://services.aamc.org/currdir/section2/03-04hottopics.pdf. Last accessed January 26, 2006.
- General Competencies; ACGME Outcome Project. September, 1999. Available online at: www.acgme.org/outcome/comp/compMin.asp. Last accessed January 27, 2006.