Medical Mediation: Building Better Dialogue Between Families and Healthcare Professionals

Posted on: June 18th, 2019

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.

Case study: Abigail's story

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.

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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.

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.

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