We commonly find ourselves needing to communicate with the next of kin & relatives.
Do you have consent?
Remember that you don’t need the patient’s consent to gather information or concerns from their relatives. However, you must ensure you ask the patient whether they’re happy for you to share any information with them. It is helpful to check what information they would like shared & with whom. Always try to update the next of kin or relative(s) in the same room as the patient. For medicolegal reasons & for future colleagues, ensure you carefully and thoroughly document.
If the relative cannot attend the hospital, you could consider asking them to phone the patient’s number and updating them this way. You can then verify it is indeed the right person & the patient is also able to listen in.
If the patient cannot consent, the GMC has quite clear guidance on this. Firstly, you can always listen to any concerns a relative may have without needing a patient’s consent. Should you need to share information, then it might be reasonable to give general information about the patient’s current condition if you think that’s what the patient would’ve wanted. If the patient is likely to be able to regain the ability to consent soon, it may be more reasonable to wait for this to occur. Whatever you do, ensure you put the patient first prioritising their care, dignity & privacy.
How to Communicate
- Before you go, ensure you update yourself with the most recent developments
- Also do find a suitable environment to update them based on the sensitivity of the conversation you’re about to have – particularly if you’re breaking bad news
- Make sure you know who they are & they know who you are
- Start by ascertaining how much the other person already knows, this will make it easier for you to reference in the course of the conversation
- Break up topics into small chunks and ensure the other person understands (avoiding medical jargon)
- Invite questions rather than just give lots of information, this keeps the conversation centred on the other person’s concerns
- If you are on-call and only have a few moments, make this clear at the start or if possible ask a colleague to hold the bleep
- Offer to have another colleague present if you pre-empt a difficult situation, i.e. an angry/upset relative
- Clearly document what you and the other person have said in the notes when finished, if there are any concerns or unresolved issues inform your seniors and/or other members of the MDT as needed. This is particularly relevant if you are not the main team doctor, e.g. on-call.
- If you need to speak to relatives over the phone, e.g. in an emergency situation, be mindful to keep to a minimum, particularly if you have not met in person and advise them to come in person where you can provide more information.
Top Practical Tips
- Don’t be scared! Most people just want a general update because they’re worried about a loved one. Just hearing “they’re okay” is often enough.
- If you’re on call, it is often better for the patient’s usual team to update the family. This prevents you giving incorrect information due to the limited time you have. Also, it enables you to prioritise the often more urgent tasks you have outstanding.
- If there are multiple family members that are calling/asking for updates, this can impact your ability to deliver care & can result in mixed messages. It is helpful to designate one person to receive all updates as decided by the patient. They can often be given a password for telephone conversations.
- Feel comfortable admitting that you don’t know the answer to a question & offer to find out
- Documentation should include who you spoke to, when, whether the patient consented & what (if any) information you shared
How do you tackle tough questions?
I’ve kept a list of common tough questions below with some suggested answers:
Why have I not been updated until now?
I’m sorry about this. With the number of staff, patients & often relatives, it is difficult to keep track of exactly who has been updated & about what. Typically, we do try and update the next of kin every time they call or come in requesting an update. Additionally, if someone gets unwell or is ready to go home – this is another time we do try to reach out.
Will they recover from x illness?
It is difficult to answer this with any certainty because of how frequently things can change. And believe me, if I could answer your question, I definitely would! However, be assured that we will ensure we provide all appropriate treatment and keep you updated if there is any change.
How will you ensure this [illness/fall] doesn’t happen again?
We will definitely continue to prioritise their care involving specialists & other healthcare teams as needed to put in place a thorough plan. That said, even if we do this, there is no absolute certainty that we can prevent it from happening again. Often even if you & we do everything right & with constant supervision or review, some things cannot be prevented.
Don’t you know about “x”? I’ve raised it so many times!
I’m sorry that you’ve had to raise it several times. I’m not aware, but that doesn’t mean that my colleagues aren’t. We all focus on different aspects of care and so there are different teams for each thing. Just in case it hasn’t been acknowledged, do tell me more details so I can ensure the relevant people do know.
Why is there a delay? For discharge/scan/transfer etc.
Most commonly, because an urgent or life-threatening situation has taken priority or there is another issue that would mean it is unsafe to go ahead. Whilst I don’t know the exact reason, I can endeavour to find out. Be reassured that just because there is a delay with x, it doesn’t mean we aren’t addressing/treating/managing other things. Also, when I do try and find out, I will again try to raise it to the right people to expedite things as it is important to me too that things are done in a timely but safe way.
Further Reading & References
Written by Dr Akash Doshi (ST4) & Dr Paula Busuulwa (FY3)
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