Tuesday, September 26, 2006
Speak Up or Shut Up: What's a Health Care Provider/Family Member to Do?
BY CAROL LEVINE

What’s the appropriate role of a health care professional when a family member is in the hospital? Two physicians, writing in two major newspapers on the same day, come to opposite conclusions.

Benjamin Brewer, a family practice physician in the rural village of Forrest, Illinois, has no patience for family members who are also health care professionals and whose “steady stream of second guessing… gum[s] up the works” (“When the Family Health Expert Second Guesses the Doctor, Wall Street Journal, September 19, 2006). On the other hand, David A. Shaywitz, an endocrinologist in Boston, says that “relatives who watch over everything, question everybody, and make a nuisance of themselves…may be a patient’s most important advocates” (Overattentive Families May Be Underrated,” New York Times, September 19, 2006).

Shaywitz recounts several anecdotes from his family’s experience when relatives recognized serious complications in their hospitalized family members (one a child), demanded immediate attention, and thereby prevented further harm, even death. He points out that in today’s world of “rapid-fire medicine,” doctors in hospitals are responsible for scores of patients at the same time and spend most of their time focused on the sickest. Resident physicians, as he recalls only too well, can be annoyed by families who always seem to have just one more question, when there are 25 other, sicker patients who need attention. The residents may feel guilty because they can devote such a small amount of time to most patients.

Get over it, says Brewer, in so many words. “Though I used to spend a lot of time trying to win the trust of [people who are overly demanding], now I rarely make that kind of effort. I don’t have the mental energy or the time for it.” If these folks don’t think our little hospital in Gibson City is good enough, or if they can’t wait for a specialist to find time to see them, they can transfer their relative to a “bigger, better” medical center, he says. “They’re more satisfied and they can stop second guessing Dr. Brewer.”

Anyone with a medical background planning to visit relatives in that area between Thanksgiving and New Year’s should be wary, since Brewer is especially annoyed by out-of-towners who show up in his ER around the holidays and complain that Mom doesn’t look so good, when all that is wrong is “normal aging coupled with weakness due to loneliness and inactivity.” Mom is lonely and inactive? The good doctor has turned a holiday visit into the perfect definition of a guilt trip.

Both physicians focus on relatives with health care training. If these family members have to demand attention to clearly urgent problems (Shaywitz) or encounter indifference or hostility (Brewer), what chance does a non-medically trained but observant family member have? Not a lot. Physicians and nurses generally agree that family members without medical credentials who ask a lot of questions and demand attention are nuisances.

Ironically, in a “consumer-driven” environment, where we are all urged (by the Wall Street Journal, among others) to treat health care like any other commodity, asking questions about the product gets you into trouble. And in a health care environment striving to prevent medical errors, ignoring the people who know the patient best and are alert to every change and symptom is both arrogant and unwise.

I’ll go with Shaywitz’s advice and take the consequences: “If you see something that doesn’t seem right, speak up.” To take a phrase from our current security lexicon, “If you see something, say something.” The era of the passive patient and family member, trusting in the omnipotence of health care providers, is history.

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