Question from the Road: Family Keeps Blaming Me?

I write this e-mail as I am traveling home from a Sorry Works! presentation for a Western hospital.  On a Saturday morning I had a room full of 40+ docs and we discussed disclosure for nearly two hours.  It was a great crowd.  I went through all the usual stuff of empathizing and staying connected with patients and families post-event without prematurely admitting fault.  After my presentation, one of the docs asked this excellent question: "What do you do if you have tried to empathize post-event, promised a review, and have tried to keep the conversation and relationship moving forward, but the family just wants to blame you, blame your colleagues and the hospital, and keep arguing and yelling?  What do you do?"

Great question.  Several thoughts.

Continue to listen and acknowledge their feelings: "You have every right to be upset and angry, and if I were you I would be angry too.   Again, I am sorry this happened, we are going to do a review as quickly as possible to learn what happened, and begin reporting back to you at 3pm tomorrow afternoon.  Now, is there anyway I can help you right now as far as food, transportation, lodging, a minster, or other issues?"   Sometimes people need affirmation and to know they are being heard.  Also remember to show good body language and eliminate outside distractions and noises.

Do everything you can....to a point.  Disclosure is NOT an open-ended invitation to a never-ending argument or verbal beat down by a family or patient.  Don't get sucked into an argument and don't get defensive.  Instead, at some point you have to break it off in a polite fashion and leave the situation...and then document everything!   Also, this is where having a 2nd person in the room from your side can be very important as a witness, for documentation concerns, and to possibly help re-direct the conversation.

Going forward, you can try again to re-engage the patient or family when, for example, they need to be updated on the review.  You may also consider asking another colleague, partner, or someone from risk or administration to try to take over the on-going discussions with the patient or family.  Maybe you have bad chemistry with this family.  Or maybe the family is simply too angry to listen to anyone at this point and needs some space and time to cool off.  Or maybe they are simply disagreeable people - "hot heads" -  who are not able to interact with other people in stressful situations.   Or maybe they are just crazy.   Every situation is different.   This is why having a disclosure program is so important, so collectively the team can decide the best course of action going forward.

Dr. Gerald Hickson and his terrific team at Vanderbilt teach that at some point it's OK "To agree to disagree."  You can reach a point in the disclosure process either at the empathy stage or all the way at the end during resolution where you simply can't communicate and reason with some people.  Again, don't get sucked into never-ending arguments and don't become defensive.  Keep your cool.  Try two or three passes and if they simply want to argue and fight, then politely say, "I've acknowledged your feelings, we have reviewed the situation, and reported our findings to you, but we agree to disagree and there is nothing more I can do for you or your family at this time.  I'm sorry."  

This approach and thought process should be kept in mind all the way through the end of the disclosure process including resolution where a) you admit fault but can't agree on compensation or b) say you didn't make a mistake but the family believes otherwise.

At Sorry Works! we have always taught doctors and nurses to be empathetic but also have a backbone.  Stand your ground, especially if you didn't make a mistake.  Nor should you turn into an ATM machine when you did make a mistake. Using Dr. Hickson's strategy is great way to show backbone with people who want to be unreasonable.

And remember to document everything!  Every conversation, every attempt you made to stay connected post-event.   You want to be able to show you tried to work through the disclosure process with the patient or family.

To schedule your own Sorry Works! presentation, simply call 618-559-8168 or e-mail doug@sorryworks.net.