HOUSEMEN ONLY troublesome family members

Managing 'troublesome' family members of patients

Medical wards are almost always very busy. Housemen are always running out of time. Our day typically begins before 6.30am once we step into the ward. It doesn't stop till maybe 1pm on good days after most plans have been carried out after rounds done with the specialist. If we are slightly unlucky, we might still have a short break at around 4pm. It's usually the most quiet period between 4 and 7pm. By saying quiet it means fewer admissions. But this is also the time when visitors start to crowd the ward. SN will start calling for houseman because family members will want to know whatever going on with their family who got warded. It is essentially an important skill to deal with these laymen because if you're good at it, it makes your life easier. You get to take a little more breather before the next wave of admission hits the ward. 

How should we deal with these people?

First, we must understand that these people ask questions because they care. Therefore, it is good for the patient. Our aim, on the other hand, is to discharge the patients as soon as possible so we have to make sure they get better sooner. Having caring family members actually help in recovery of the patient, as said in many statistics. So it is a synergistic outcome if dealing with family members is a smooth process. 

Most family members would want to know when we can discharge the patients home. Some would want to know what's wrong with the patients, and what treatment plan has been given. Some would ask for bargains and those who do usually won't stop asking for more. Speaking from past experience, in order to make sure they get answers satisfying enough for them to stop asking sooner, we have to flood them with ideas and knowledge they never knew. However, use layman terms as much as possible. 

Simplify. 

For example, patient has been given 3 types of IV antibiotics in the ward and was given 2 types of S/C insulin at different times of the day. She/He has also been given KmNO4 bath/soak over the cellulitis skin. And when the family wants to know about the treatment in the ward, tell them in extremely simple language: We have checked the blood and found out that there's been an infection going on. This explains the temperature spikes, redness, swelling and pain. However, we have been giving your (fam member) antibiotics through the veins directly into the blood. We have to keep him here for the time being because we cannot give them tablets as it is not sufficient. So far, there has been commendable improvement. What else would you like to know? 

Always tell only one thing at a time, and explain in details in a language as simple as possible. This is because most of the time they can only understand one thing at a time. Tell them the details so they know that many things have been done in the ward and it is necessary for us to keep the patient here. Put it into words in a way which will make them feel that we are always monitoring the progress. Do not attempt to tell them minor details such as giving insulins etc why putting bath soaks and etc. Only tell upon being asked. Because they might be confused and in the end we have to spend another 10 mins repeating the whole thing. Also, ask them what else they'd want to know more immediately after the explanations. This is because, most laymen will need more time to digest whatever details being told, and when we ask them questions while they are still recalling things being told, most of the time they will say no, and that they have understood everything. Now we can quickly disappear and continue with our other chores. 

What happens when a family member wants to know about a patient who isn't under your care? 

Try to find the houseman. But my experience is, it will take more time looking for them than dealing with the family members myself. 

First, let them know that the houseman in charge is dealing with other patients at the moment. However, you will want to try to answer their questions as much as you can. Flip through the BHT, ask them what would they want to know. Look at the latest plan, pick on one thing  which is most significant, usually e.g. treating with IV antibiotics, or planning for a procedure. Pick on only ONE thing, and start talking and explaining. Add in elaboration on why we usually do it for the patient. Try to talk more than being asked so they have no chance to ask a second question. After that, immediately ask whether they have more questions. If they asked something you can't answer immediately, tell them you're not sure but you will revert to the houseman in charge. But also try to tell them why usually it's done, e.g. on other patients. 

These are some simple tips to deal with family members who care.

Important points are, give explanations. Ask for their concerns. Clarify. 

We have to understand the motives of the questions being asked. And the motive of them wanting to ask a question. Tackle the reason, deal with the motive. Simplify. Say something they can digest and will be able to bring home and tell other family members. So you don't have to do multiple talkings.