Caring for the Family Is Part of the Job, Too

Living with my mom, who is a home health care hospice nurse, I am learning all kinds of things. As she was relating her "adventures" the other day, something dawned on me. And while this may sound obvious, it is something that I believe many physicians forget to consider. But it is something I believe we should consider, on a daily basis. I know that after this realization, I will be.

As medical practitioners, it is key for us to consider a patient's family, in addition to the patient's own well-being, illness, and treatment.

Why? For one thing, the family helps create the environment in which the patient lives, which can definitely (and sometimes adversely) affect the patient's well-being, illness, and treatment. An example from my mom's experience: she had a patient who was declining, health-wise, and had required a long visit. The patient's caregiver, another family member, mentioned that one of the patient's sons was supposed to come visit later that day. But the caregiver was concerned about this visit, and having to relay the news his mother was declining, because the son had serious mental health issues. My mom asked whether it was possible that the son might hurt someone, or himself ... and the caregiver said, basically, I'm not sure. That impending visit - clearly a family issue, and not a specific patient health issue - might have put my mom's patient in a dangerous situation. So my mom brainstormed with the caregiver, and they decided to cancel the visit that was supposed to happen. My mom also called one of her hospice's social workers to help with the situation. (Another lesson: it's important to work as a team, and to know what your resources are.)

In hospice, and in other scenarios (especially ones involving the elderly, and long-term, chronic conditions), family members are often the ones giving care - administering medications, that sort of thing. While the family members might not even have a high school diploma, they are being asked, in essence, to act as nurses or nurse's aides for the patients. So it is very important to take the social and family situation into account, and make sure the family members are adequately educated about the patient's care.

With other diseases, such as diabetes, the family environment can very much affect the patient's condition. For example, if the family members often cook fried foods, and incorporate very few vegetables or healthy foods into their diet, that is a serious problem for maintaining the patient's blood glucose level, as well as cholesterol, blood pressure, and other common comorbidities of diabetes. Then you wonder why the patient's hemoglobin A1C comes back at 10 ... so understanding the social situation, again, is imperative.

This does, of course, take some effort. And effort requires a bit extra time. Which, of course, is always in short supply for physicians. But I believe that it falls in the category of preventive care, which can save time, money, and a patient's health in the long run. So isn't it worth it?