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 crucial healthcare decisions. What we need in such situations are clear information, support to make the right choices, and the honest opinions of people who we feel we can trust.
The key to minimising the stress of such decision-making is the quality and regularity of communication with health professionals. And despite everyone’s best intentions, conversations involving patients, relatives, and those responsible for delivering medical care can and do go wrong in several ways:
- People may have a high expectation of what can be achieved: they have read or heard (often from ‘Dr. Google’) that people with similar conditions have improved or even been cured, and they want the same for themselves or for their relative
- The technology involved in medical diagnosis and treatment has become highly complex, putting a far greater burden on clinicians and nurses when interpreting and explaining detailed information to people who are not medically trained
- Ethical questions, especially concerning the withdrawal of treatment, can be strongly influenced by people’s religious and cultural background. And in the case of very sick children, while parents do have legal rights, the child also has rights: a decision to act in the child’s best interests may ultimately go against a parent’s deeply-held wishes
- Put simply, it is hard to predict the 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
The Health Service Ombudsman, in a consideration of healthcare complaints, has said that, ‘Time and again, poor communication with patients and their families is at the core of what goes wrong’*. Clearly, what is needed is way to facilitate these difficult conversations: ensuring that expectations can be set realistically, that complex information can be provided in a comprehensible way, and that thorough dialogue takes place about any ethical or moral imperatives, especially concerning the withdrawal of life support.
Mediation meets this need perfectly, and here at UK Mediation we have for some years now been training health professional in mediation skills, ready to facilitate conversations between patients, relatives, and health professionals. Our particular focus has been on training registrars, consultants, staff nurses, community specialist practitioners and matrons, and our particular area of interest has been in paediatrics and neonatology.
Mediation in this setting provides a perfect way to build better dialogue. Trainees of ours, ALL of whom say that their use of mediation skills has improved their day-to-day practice, especially point to the following areas:
- Using mediation skills, they can firstly stop, thoroughly listen, and better see the situation through the parents’ eyes. There has been a switch away from offering early reassurance, and towards spending that time getting a better picture of parents’ particular fears and concerns
- By expressing greater empathy with the parents’ predicament, the parents feel less afraid and overwhelmed, and become more ready to listen to professionals’ explanations and complex decision criteria. They can then be more confident about the decisions that they actually want to make.
- With the support of the mediation skills model, there is a better structure to how the conversations need to go: especially when two parents, sometimes estranged, are not on the same page with making a critical decision, the practitioner can bring about better collaboration between them
- Problems in communication can be spotted early on, before conflict begins to escalate. By addressing conflict before it grows, professionals can head off many more potential disputes or complaints. Situations have also been contained better because of the early intervention, and have especially not made their way onto social media, with all the negative effects that can bring about.
Working with partners in a number of hospitals, we are delighted to have been able to contribute in these ways to enhancing the quality of these most difficult conversations. Sometimes, however, things have moved on too far before they are spotted, and there is a breakdown in communication with the hospital that is more difficult to retrieve. Parents lose faith in the professionals; they can act out, either face to face or over social media; they stop listening, and the next step can often be that they to go to court.
In these cases, what we have been able to offer is the intervention of an external mediator. I or one of my team can offer to go into the hospital, to invite the parents to get together in a confidential setting with the professionals, and to mediate between them. Court action is consequently headed off, adverse reporting (including trial by Facebook!) is minimised, and both ‘sides’ can feel that they have been thoroughly heard and understood, and that the right decision has ultimately been reached.
When emotions are running high, when people need to resolve such difficult issues but want to avoid a dispute at all costs, mediation is a fantastic way to build dialogue, to restore trust, and to provide the conditions for people to make some of the most difficult decisions they may ever need to make.
I hosted a webinar on the subject of medical and health mediation, on Friday 15th December. Watch a recording of the webinar
* Listening and Learning: The Ombudsman’s review of complaint handling by the NHS in England 2011-12. Pub: The Parliamentary and Health Service’s Ombudsman, 2012.