Intended for healthcare professionals

Rapid response to:

Observations Ethics Man

Don’t forget the relatives

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7351 (Published 03 December 2014) Cite this as: BMJ 2014;349:g7351

Rapid Response:

While agreeing with Daniel Sokol as far as he went this is a Pandora’s Box and there are informal practical issues that can interfere with ideal patient and family management. The fact of contact with relatives is inextricably tied to the content of any exchange.

For example, there is a problem quite opposite to the under-engagement with relatives that he describes, which is the poorly co-ordinated reporting on seriously ill patients by several staff members from the same or different clinical teams. Briefing routines vary from hospital to hospital, unit to unit and from time to time. With the best of intentions there is a tendency for reports to interpret the clinical status, current concerns and prognosis from a variety of perspectives and in terms overlap. This can cause confusion among family members and groups of relatives. A kind of multiple jeopardy of misunderstanding is enacted.
Literal-minded, anxious, relatives are particularly likely to react to inconsistency of reporting and become mistrustful because of it. The clinical context is important because mistrust is already sewn systematically as an unintended consequence of the publicity around hospital-acquired infection, for example.

Such exceptional circumstances deserve early discrimination from the common view that simply providing information to relatives will obviate complaints, since that approach can make matters worse. As indicated in the article, the coincidence of extended suffering, a mortal illness, particular infections, the plausibility of clinical error and a literal mind-set should flag a need for special care in the lines and content of communication with relatives.

Competing interests: No competing interests

09 December 2014
Eric J Will
Retired Nephrologist
Leeds Teaching Hospitals Trust
Beckett Street, Leeds, W Yorks LS9 7TF