In our modern day context the doctor patient interaction is no longer confined to simply communicating

with only the patient. Communication often involves family members of the individual as they too are
present. Thus navigating such interactions are all the more complex and a whole set of issues arise from
such a situation. Not only are there a variety of cultural and relationship dynamics to take into
consideration but issues surrounding the patient’s confidentiality, consent and patient safety.

Although the presence of the family and the communication issues that can arise may make the doctor
patient interaction more complicated and perhaps place more stress on already present time constraints,
the role and presence of the family is something that cannot be ignored. The family can provide
substantial support to the patient both emotionally and physically. They can also positively influence the
patient’s beliefs and compliance as a whole. Thus it is so important to be able to tackle the issues and
detrimental consequences that can arise in order to effectively address both the patient and their family.

One major issue that can arise when communicating with the patient whilst family members are present
is confidentiality. Although some patients may be completely comfortable with sharing information with
their family others, may not. Not only is there confidentiality concerns with the family present but also
privacy concerns. This is especially the case in the situation of physical examinations when the patient
might not feel comfortable in the presence of family members. Therefore in order to respect the
confidentiality and privacy of the patient it is important to ask beforehand whether they would like their
family present. If they don’t want them present be sure to express this to the family members so they
understand. This may be difficult and they may persist to be present but is important to reiterate in a
respectful manner the patient’s request for privacy.

Another issue that can arise when communicating to the patient in the presence of family members is
consent. The presence of family members can bring about undue pressure and they may try to influence
the decision making process of the patient. Family members may not only bring in their personal beliefs
and judgements but also their cultural beliefs. These may conflict with that of the patient. If such family
members try to coerce the patient when making a decision, this undermines the principle of informed
consent as the patient is no longer making the decision on their own accord. Thus in order to value the
autonomy of the patient it is important to try and hear out their opinion and decision. If the patient feels
uncomfortable coming to a decision in their presence perhaps request to speak to the patient alone. At
the same time it is important to hear out the concerns of the family members. They may be basing their
beliefs off previous incidents or anecdotes so try and acknowledge their concerns, answering any
questions to the best of one’s abilities.

Although it may be easy to assume who the patient considers as family sometimes the patient may not
feel completely comfortable with the other individuals present in the room. Unfortunately the patient
may be vulnerable to abuses of power from other family members. Such abuse may be physical,
emotional or even financial. Similar to issues surrounding confidentiality it is important to communicate
in private with the patient beforehand who they feel comfortable around and who they personally
identify as family. Try to gauge the patient’s support system and contacts as well as their current
relationship to particular family members. Should the patient express concerns that are more serious
there may be need to get in contact with the relevant legal or social services in regards to reporting any
abuse, neglect or exploitation.

At the end of the day the family is an important part of the patient’s support system, influencing their
care and treatment in the long term. It is important to appreciate their support and their presence as a
whole. Acknowledge any issues or concerns they might have and provide them with adequate
information. At the same time value the privacy, confidentiality, autonomy as well as safety of the
patient. Although each interaction is unique in its own way it is important to be aware of such
communication issues so we can better engage with the patient and their care.