Angry daughter

Question 1

You are the medical SHO covering the AMU. One of your patients is a 66-year-old gentleman who has been admitted with haemoptysis. Following investigation it has been discovered that he has a primary lung cancer. The nurse in charge of the AMU asks you to speak to the patient’s daughter. She demands to know what is wrong with her father because “he won’t tell me.” She appears upset and won’t leave the nurse’s desk until she gets answers. She has been shouting at the nurse in charge for the last two minutes and this is why you have been called.

How would you approach this situation?

Answer 1

Issues raised
This scenario raises the issue of patient confidentiality and conflict resolution and trying to diffuse a potentially hostile situation.

I would approach the daughter and introduce myself and explain who I am. I would ask her to accompany me to a quiet room where we won’t be disturbed and ask the nurse in charge to join me to help facilitate the conversation.

I would ask her to explain why she is so upset, what information does she have and what has she been told so far?

I would explain that her father has the right to patient confidentiality and that without his permission I cannot break it. I would offer to speak to him and explain that his daughter is upset. If he allowed me to, I would then discuss the care.

Then, I would ask her to remain in the room for a few minutes after this conversation to reflect on what I said. I would stress that while I understand the difficulty of the situation, her behaviour towards our staff was unacceptable and that it will not be tolerated.

If she refuses to calm down or becomes aggressive, I would have her removed from the ward by the hospital security.

Question 2

What steps could you take to try and help resolve this situation?

Answer 2

The issue here is between the patient and his daughter. He has decided not to tell her what is going on. I would talk to the patient and try to understand his decision. It may be that he doesn’t want to upset her or that he doesn’t know how to tell her.

I would try and explain her concerns to him and try to make him see how upset she is being kept in the dark. I would also offer the patient help – I could speak with the daughter if he allowed or be present when he tells her to offer support. I would also explain the benefit of having his family close by and supporting him.

Hopefully in this way I can both diffuse the situation that has arisen on the ward and also help my patient come to terms with his diagnosis.

Question 3

Why is confidentiality important?

Answer 3

Confidentiality is integral to the doctor patient relationship. Without it there would be no trust and patients may not divulge essential information, which may be needed for diagnosis or treatment.
Confidentiality is part of patient autonomy and patients have a right to choose who their information is shared with.

Question 4

What simple steps at work can you take to avoid breaching confidentiality?

Answer 4

• Ensure patient notes are stored securely and not left on surfaces unattended.
• Lock computer screens when not in use to protect patient information.
• Keep handover sheets anonymised and dispose of them in confidential waste bins.
• Ask patients for consent if they are accompanied before discussing or examining them.
• Obtain explicit consent from patients before sharing information with relatives or friends.
• Never share patient details on social media.
• Use “code words” for sharing information over the phone with consented individuals only.