Most doctors have encountered them at some point: a patient’s complaining spouse, controlling daughter, or aggressive son-in-law who questions every care decision. Dealing with difficult caregivers is a common issue. There are 93 million family caregivers in the U.S., and four in ten adults in the U.S. are caring for an adult or child with significant health issues. Many of those caregivers report having high levels of stress, difficulty balancing work and family responsibilities, and little time to take care of themselves and their own health. All that stress and pressure can add up to an unhappy person who’s hard to deal with. Here’s some advice for doctors on how to handle these challenging caregivers while giving their patients the care they need.
Listen and learn
The first rule is to avoid taking the behavior personally, writes Arlene Boudreaux, MSN, RN, in a Nursing2015 journal article. Put yourself in caregivers’ shoes and remember that they are concerned about the patient and aren’t being intentionally difficult or aggressive. Try to understand what is behind controlling behavior like insisting on staying with the patient at all times, or questioning why certain tests and procedures weren’t performed. “The root of controlling behavior is fear, anxiety, and possibly guilt,” writes Boudreaux. Resist the urge to get defensive.
Instead, make an effort to be an active listener. Difficult interactions often have to do with poor communication and misunderstandings between the physician and the patient and family, notes physician Sheila M. Bigelow on Medscape.com. It’s important to listen “actively” – meaning, when the other person is talking, you stop and listen rather than formulating your response. This can be a challenge for doctors. “This happens more often when we are upset or not understanding why a family is making a certain choice,” writes Bigelow. “Sometimes a patient or family just needs to vent. Most often, the skill of active listening will ease a difficult situation.”
Involve and educate caregivers
After you have heard the person out and really listened to their concerns, focus on forming a partnership with the caregiver. Shared decision-making, which may include caregivers as well as patients, leads to better outcomes. Boudreaux notes that some family members may feel that they are the only ones who know how to care for the patient properly. “Take advantage of this attitude by making them feel they’re valued members of the patient’s healthcare team. This in itself will reduce their stress and help them regain a sense of control in a positive way.”
Statistics show that caregivers are a tech-savvy bunch. Most are adults age 30 to 64, and they are more likely than non-caregivers to gather health information online, research symptoms online in order to find a diagnosis, and consult online reviews about drugs and other treatments. Of course, there are pros and cons to seeking health info on the Internet, as doctors know. “Family members may have acquired erroneous information from the Internet and other outside sources,” writes Boudreaux. “This is an excellent opportunity to educate them about the disease process and treatment” and refer them to reliable patient education sources — such as your own materials, which preferably are digital, shareable, and easily accessible by all members of the patient’s care team.
Dealing with a critical, rude, and even aggressive person is never easy. “If you feel as though your temper is starting to boil, take some deep breaths, leave the room if you can, and come back when you have both cooled off a bit,” advises Bigelow.
It’s important for doctors to show empathy in their interactions with difficult caregivers and patients, not only because this is a major factor in malpractice lawsuits, but because being nice and remaining professional is in the best interest of the patient. Treat the patient’s family as you would hope that a physician would treat your own family, recommends Bigelow. And remember that your job is not to like every person who comes into your practice, but to provide all your patients with the best care possible.
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