Editor's Note
The Crowd in the Exam Room
I scanned the exam room looking for a place to sit. The only available perch was the exam table. Wally sat in his wheelchair, and the remaining chairs, including the one at the desk where I usually sit, were taken by his wife and two daughters. All three held notepads with lists.
Based on Wally’s recent hospitalizations, when one of the daughters or his wife would sleep in the room and be ready with questions for me on morning rounds, I knew I was in for a challenge. Sally, a physical therapist, led the way with inquiries about his feeding tube, antibiotics, Coumadin, and ongoing therapy at the nursing home. Like a reporter at a presidential news conference, Ann, her sister, would ask follow-up questions. His wife chimed in with short comments. By the time I left the room, the scheduled 15-minute appointment had more than doubled in length.
Most of the questions were relevant, and certainly all of the family’s concerns were valid; but the visit left me exhausted. The presence of family or friends in the exam room can test the art (and patience) of any medical practitioner.
Family members frequently fall into one of five categories. There is the Spy, the child who requests the clandestine rendezvous in the hallway to tell you about mom’s failing memory or the need to take the car keys away from dad. Or the Storm Cloud, the daughter who greets you with a scowl, speaks to her mother in sentences laced with frustration and anger, and who interrupts your interview with argumentative attacks from across the room. Or Familius Interruptus, the spouse who repeatedly corrects the patient’s story—“I went to the emergency room…”/“No Tom, it was urgent care.”/“Anyhow, I got this dizziness and…”/“And you didn’t tell me about it when we were in church.” Or the Coach, who guides her 93-year-old spry, nervous mother through her history of heart pounding and fatigue—“Mom, you need to tell him about the heart pounding before you talk about the bad dreams”—or helps you take the history: “Did you take the HCTZ yesterday?” “When do you feel like that?” Not inappropriate questions, but I ask myself, “Who’s supposed to do the asking?” The most troublesome types are the Hatfields and the McCoys, the multiple family members who battle in front of you and the patient.
Irritation and comedy find their way into our encounters with family; but the crowd in the room is frequently an absolute necessity. Family members report those falls that the patient would rather not mention, the daily headaches that have evaporated from a failing memory, or the anger and mood swings that the patient doesn’t notice. They can advocate for passive, feeble parents, making sure the medical system does its job. And the spouse who sleeps in the hospital room can serve as an additional nurse or aide.
We all may be part of the crowd in the room sometime. In May, my father-in-law was admitted to a transitional care unit in Chicago after an orthopedic procedure. A few weeks after his admission, he started sounding confused during our daily phone calls. Without success, my wife and I attempted to get an evaluation by one of the nurses. When we visited, he was obviously hallucinating, and after we notified his physician, he was admitted to a local hospital with MRSA sepsis. Our intervention was timely and perhaps lifesaving. Although sometimes pesky or persistent, family as observers or caregivers can be an invaluable part of the medical team.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org.