The family as an ally of doctors

Christina categorically refused to leave the hospital when her husband’s surgery was over. The nurses, to put it mildly, were unhappy: it was pointless to ask them for a cot or at least a chair. But Christina still stayed and spent the night on a chair in the corridor. In the morning, a nurse, who had just taken up duty, came to give an anesthetic injection. Christina barely had time to grab her hand when she heard the name of the medicine: her husband had a severe allergy to this drug. Of course, this fact was noted in his medical record, but no one looked into it in time.

Each of us must have heard such stories, and yet we still want to believe that, in general, we can rely on the professionalism of doctors. Alas, in both Europe and the United States, as many people die from erroneously prescribed drugs in hospitals as from car accidents. And some hospitals have already drawn reasonable conclusions from this. At a University of Pittsburgh clinic, I saw this sign on the wall: “We encourage the patient’s relatives and himself to check the names of all drugs that are prescribed to him, and ask the staff to report any cases of drug misuse or intolerance to the staff.”

For years, doctors have been trying to build a system in which the risk of error would be minimized, but each time they come across an obvious contradiction between theory and practice. In theory, doctors and nurses are competent, responsible and able to provide the patient with qualified assistance, but in practice. In practice, it turns out that the risk associated with the “human factor” cannot be completely eliminated, especially if the staff is overloaded (and we know that this happens very often). In such a situation, doctors can “share” the responsibility for treating the patient with him and his family – for the sake of his own safety. So there was an ad that caught my eye.

When I was working as a pediatrician at a MSF hospital in Kurdistan, a physician colleague, who is much more knowledgeable in pediatrics than I am, clearly explained to me why the participation of relatives is so important in our work. “In children, both serious and generally harmless diseases often present with the same symptoms. Besides, children cannot explain to us exactly what they feel.” Indeed, all the babies who came to us with a high temperature had the same symptoms – vomiting and diarrhea.

Older children said that they were sick and their stomach hurt, but this did little to help diagnose. So, my colleague paid attention primarily to the mother’s condition: “Diagnosis is 80% based on the mother’s anxiety. Don’t dismiss this symptom! She knows her child much better than you!” This is obvious to any mother, but I had yet to learn to trust my mother’s intuition, not relying on the deceptive objectivity of a thermometer or a stethoscope.

And one more observation from that field hospital. When a patient came to us, his whole family came and settled with him. Often the patient’s mother and spouse would sleep with him in the same bed, prepare meals for him, and feed him during the day. In such a situation, doctors simply could not help but cooperate with relatives. Needless to say, in developed countries this is unthinkable. In our hospitals, ubiquitous relatives asking too many questions annoy doctors; we doctors are afraid to spend too much of our precious time on them when fifteen more patients are waiting for our attention

Nearly all over the world, hospital conditions are becoming more difficult every year: the shortage of time and money in healthcare is growing. This means that the role and responsibility of the patient and his family will inevitably increase. Families will be in a better situation if they learn to work with doctors as a team instead of fighting them.

If something is worrying or disturbing you, do not hesitate to tell the doctors about it. And, if you appreciate their work, say so too.

* «Preventing Medication Errors». National Academies Press, 2006.