Conflict in the exam room: Four ways to deal with patient-family drama

February 25, 2020

Chris Mazzolini is the editorial director of Medical Economics

Logan Lutton

How physicians can deal with the growing problem of family conflict in the exam room.

Along with all the advantages of having family members on hand for appointments and involved in treatment and care, they can bring something else: the potential for conflict.

Physicians can often find themselves entangled in family dynamics, including rivalries, unsettled feuds, lingering anger, power struggles, greed and much more. Obviously, it’s not where a physician wants to be.

This slideshow continues tips from three experts on how physicians can handle this type of conflict. They are: Nitin S. Damle, MD, an internist in Rhode Island; Myra Glajchen, DSW, director of medical education at MJHS Institute for Innovation in Palliative Care in New York; and Bernard M. Bandman, Ph.D., co-founder of the Center for Communication in Medicine in Bennington, Vermont.

It’s increasingly common-especially as the Baby Boomer generation ages-for patients to bring a family member with them to appointments. According to a National Institutes of Health study, member more than 37 percent of routine adult medical visits involved a patient bringing a family member with them.

“You have a short time in which to meet with a patient and family,” Glajchen says. “It’s unrealistic to think you’re going to be able to resolve longstanding family conflicts.”

She recommends that doctors acknowledge the family tension as soon as they encounter it and tell family members that its won’t be resolved in one day. “Concentrate on how the conflict is affecting the immediate situation for the patient,” she advises.

“It really needs to be named, because if it stays as an undercurrent, it's going to undermine the care plan,” Bandman says. “In some sense, the physician ends up being the therapist, and they're not necessarily trained to do that.”

Physicians should develop a referral relationship with a local psychologist, psychiatrist or social worker, says Glajchen, and then give referrals to family members in these situations, urging them to talk to someone about family issues in more detail.

Damle makes sure to talk in private with his patients about family dynamics.

“Let the patient speak their mind and voice their perspective on things,” he advises. “Then bring them all into the room to discuss what the problems might be and explain that you're not taking sides.”