Some of the most stressful times of our lives are spent dealing with our own and our loved ones’ medical emergencies or episodes of ill-health. Whether receiving bad news, spending prolonged periods in hospital, or having to make critical choices about care, our fear and upset can make it extremely difficult to contribute positively to healthcare decisions.
And, at this time, there is also a clear risk that families and healthcare professionals can come into conflict. And, when this happens, communication can break down, barriers are built up, and disputes can quickly develop and worsen.
The key to minimising this risk is the quality and regularity of communication between all parties involved. And, despite everyone’s best intentions, conversations can and do go wrong for many reasons, including:
• High expectations
Based on good feedback they’ve heard, what they’ve seen on social media, or what they’ve found on Google, people may have high, and sometimes unrealistic, expectations of what can be achieved. For example, if they see that someone with a similar diagnosis has been completely cured, they may expect the same for themselves or their loved one.
• Technological advances
With the kinds of technologies involved in medical diagnosis, there is a lot of pressure on clinicians to explain and interpret highly complex ideas to people who aren’t trained in these matters. This can lead to misinterpretations and miscommunications, not to mention potential mistrust towards the professional.
• Uncertain future
Decisions regarding the benefits and burdens of ongoing intensive care, especially in the context of scarce resources, are almost impossible to make, even without the necessity of asking parents and relatives agree to them. Often the ‘more treatment’ option will be chosen because of this difficulty.
• Ethical questions
Care decisions can also be strongly influenced by people’s religious and cultural backgrounds. And, in cases of very sick children, the decisions made in the child’s best interests may go against the deeply-held wishes of the parents.
In our recent ‘Medical Mediation’ webinar, we introduced you to six-year-old Abigail, who has a serious heart condition.
The doctors say she needs surgery, but it’s risky due to her condition and other medical complications. However, the doctors do think that it will improve her quality of life and is worth the risk.
However, Abigail’s mum, Caroline, has recently heard about a treatment offered in the US involving UV light and an untested series of injections, which she thinks would mean Abigail doesn’t need surgery. She also has sincerely-held religious beliefs and is naturally disinclined to invasive treatment.
The father, Terry, who is split from Caroline, is slightly more trusting of the medical advice, but is struggling with the emotions of the situation and having difficulty talking about things.
Either way, both parents are feeling powerless and don’t think they’re being listened to by the hospital.
The lead consultant, Dr Carlson, is resistant to the alternative therapy option being advocated by Caroline. There is no evidence that the treatment is effective and no clinical trials have been completed. He does, however, think that the longer things are dragged out, the less likely the treatment they’re proposing will be successful.
Because of this, court has been mentioned. The parents have taken umbrage and have interpreted this as being labelled ‘bad parents’ who are unable to make the right decisions for their child. This has led to anger and outbursts on the ward, with one particular incident resulting in Terry being asked to leave.
There has also been recent press coverage. Caroline uploaded photos to Facebook of Abigail and the hospital is being negatively portrayed online, especially as things snowball and other parents and advocates of the alternative therapy get involved.
In cases like this, it is becoming more and more common to see mediation used as a method of resolution.
But what exactly makes mediation so effective in these instances?
• Stop and listen
Everyone gets a chance to stop, to thoroughly listen to each other, and to better see the situation through one another’s eyes. Medical evidence and data can be better understood by families, and the professionals can get a better sense of family members’ particular fears and concerns.
• Structured process
Mediation ensures a better structure for a more productive conversation, especially when parties are not on the same page. Private individual sessions, followed by a facilitated joint session, can promote honest and open communication, rebuild dialogue, and foster collaboration.
• Promotes empathy
By expressing greater empathy with one another’s predicaments, the parents can feel less afraid and overwhelmed, and can become more ready to listen to professionals’ explanations and decision criteria. They can then be more confident about the decisions that they want to make.
• Early intervention
Problems in communication can be spotted early on, before conflict begins to escalate. By addressing it before it grows, potential disputes or complaints can be headed off. Situations can also be kept away from social media, with all the many-publicised negative effects that this brings.
So, back to the case study…
Both Abigail’s parents and Dr Carlson have agreed to mediation and, in cases such as this one, we can expect both parties to see a number of benefits from this approach.
First of all, the parents can:
• Voice their frustrations that Abigail’s health has been taken out of their hands, helping them to feel re-empowered
• Voice their desperation to find a course of action that’s less risky
• Hear facts straight from the horse’s mouth – ones that they can understand without feeling fobbed off
• Hear that medical care is not always an exact science and, while it is all based on data and assessments, nothing can be said with 100% certainty
And then, on the other side, Dr Carlson can:
• Have a chance to explain the risks and benefits of the proposed surgery
• Explain the lack of evidence in favour of the alternative treatment
• Recognise and acknowledge the levels of fear that Abigail’s parents are feeling and, most importantly, let them know that they have been heard
And, while a decision about Abigail’s treatment may not be made on the day, some agreement points can still be made to improve the relationship and begin to promote future collaboration between the parties.
For example, the agreement could look something along the lines of:
• Abigail’s parents agree that, if things begin to get heated, they will take themselves away to cool down
• They also agree to remove any social media posts about the treatment
• Both parties agree that a treatment decision will be made in 7 days’ time
It is for reasons like these why we are seeing many NHS Trusts and other healthcare providers looking to implement mediation into their current practices.
One particularly popular way of doing this is through in-house training, where clinicians and other staff can be taught how to resolve disputes themselves. This can include basic skills training through one of our tailored short courses, designed to give delegates the theory and practice required to use mediation skills in their daily roles.
However, many Trusts go one step further, training their delegates to become qualified mediators with our Level Four IMPC course. This way, they can have an internal panel of trained and accredited mediators on-site and on-hand for whenever they are needed. This course can be delivered in-house or delegates can attend one of our open-access public courses, with a specially-designed Medical Mediation Practitioner’s Certificate (MMPC) scheduled for December this year.
Alternatively, we also offer an external mediation service, perfect for one-off cases. Our mediators are trained to the highest level and have many years of experience, so you can be sure of an independent and impartial service to help resolve your disputes quickly and effectively.
And, of course, if you would like to know more about any aspect of Medical Mediation, or if you are interested in one of the above options for your organisation, please do get in touch to discuss.