August 2001 Bulletin

Caretakers need to know

Include spouse, children in treatment, recovery plan for elderly

By Carolyn Rogers

Relating well to your patients’ families is always important, but it’s even more so when the patient is elderly and largely dependent on others for their care. Whether family members are acting in a central role, or are simply there for moral support, making sure the treatment and recovery plan is understood by the patient’s family is essential.

"Try to communicate with them almost like patients themselves," says Elton Strauss, MD, chief of orthopaedic trauma and reconstructive surgery at Mount Sinai Medical Center in New York. "One thing that I always try to do is invite them over to my office. Take them out of the hallway, take them away from staring at the patient in bed."

Some husbands, wives and other family members need more attention than others, Dr. Strauss points out. "With the geriatric patient, the family is sometimes very guilt-ridden…other times they’re just very interested in what’s happening. Taking them away from the patient allows you speak more freely to them and they can feel a little freer to ask questions as well."

The environment for this conversation is important for everyone involved, Dr. Strauss says. "It shouldn’t be an on-the-run type of discussion. Obviously, if this is a patient in the ER with an open tibia fracture, it’s going to be hard to bring the family to your office. But even in the emergency room, it’s important to sit down some place with the family to talk. Make sure it’s a comfortable setting where they can tell you what they need to tell you and you can tell them what they need to know. At least it’s a start in getting a communication rapport going."

In most situations, though–such as a hip fracture–the discussion should take place in the doctor’s office. "In your office you’ll have the X-rays, models, etc.," Strauss says. "You can be more informative. Also, you’ll have the patient chart there in your office, and you can make a note that you spent time talking to the family. So there’s a medical-legal issue here as well. It’s important to note in the patient’s record that the family met with you, how much time was spent, etc."

Once a rapport with the family is established, "I try to call them at the end of the day when I have more time–I try not to speak with them during office hours."

Who you talk to also depends on who has the right to the information, Dr. Strauss adds. "You can get into problems in situations when there is a wife, but the son or daughter want to be informed first. You have to know who is actually calling the shots. Relationship issues like this are common, especially in today’s world where not everybody is married. Sometimes you have to ask who is the legal guardian, who is entitled to the information?"

Most of all, Dr. Strauss says, "It’s important to tell the truth up front. Speak to the family honestly."

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