I think, therefore I am? – Please take a seat

What the heck was going on in the lounge? A patient’s family and the doctors were sitting on the floor with their legs crossed. Were they about to break out into song? Kumbaya my lord, Kumbaya…? Was this part of the Hospice Yoga Initiative? Mat-time at a new New Zealand charter school? No, it was actually a family meeting.

Family meetings are common occurrences in healthcare settings and are organized in order to convey a point of view, or to try to bring together disparate points of views. These events may actually be the first chance that some of the key stakeholders, i.e. the family and the healthcare team, actually have to meet each other. The first time that the next of kin has made time to meet with the health care team looking after their loved one. First impressions as within any first meeting are important. As you can only meet for the first time once, you’d better do your best to make sure it goes well. In order to establish a trusting therapeutic relationship between the patient, their family and the health-care team, rapport must be established quickly. Every encounter can count, but not everything can be planned for.

“Come in, please take a seat.” Oops not enough seats, I didn’t think there would be so many people joining us. “I’ll get some more chairs.”

“No doctor it’s okay, we’re Islanders, we’re used to sitting on the floor.” He sits down on the floor in a cross-legged position and the rest of his family follow.

While dropping to the floor and re-arranging my legs into a well-versed pose, “I’m Chinese, and I’m used to sitting on the floor too.” Members of the medical team that are able to, follow suit. Eyes are in contact and are levelled, as has been some of the power differential. Serious issues begin to be discussed in a slightly different but more trusting fashion.

We are indoctrinated into doing things in a set template of fashions. This can provide structure, but can take away the humanity of these all too human(e) meetings. One size does not fit all, and within a meeting of very different people with varying agendas, establishment of rapport must occur in the first fifteen seconds. Otherwise the participants may not be present in the moment of the meeting in which momentous topics may be discussed. Deciding what a person is going to do for the rest of their life cannot be done with people who you do not trust. We need to be more flexible in our approach to this issue. We don’t want to come across as too serious and possibly even too scary to talk to, to be asked questions of. We need to be comfortable sitting alongside our patients and their families, on their journeys, even if it means your seat is on the floor.

Trying to meet people on their own level, trying to make that human connection. How does that fit in with maintaining professional boundaries and professional distance? Or are they self-protective mechanisms that sometimes get in the way of being present in the clinical moment. If boundaries get blurred too much, does that expose the clinician to greater risk of the burn-out that we all dread. Lines being blurred can lead to vision being blurred by tears. Will they still respect my opinion, if they see me cry? If I joke with them a lot will take anything I say seriously?

Balance is required: emotional, physical, spiritual, and of course, within the little community of care that we are trying to create with the family. Imbalances of power need to be addressed, people must be made to feel comfortable in sharing their views, which might be very different to our own views. Can the twain of disparate agendas be brought into meeting? Finding a common road to travel on in our team pursuit of improving the final common pathway of a human being. We need to make the meeting of minds, into a meeting of hearts.

With each relationship that we enter into we expose ourselves to risk. Take the risk of getting to know someone, of letting your professional guard down just a little bit, and maybe, just maybe some of the light will flow back in to enrich the shared experience of care. Though we do not love their loved one, we surely do care. You only have one opportunity to make a good first impression. When time is running out, every second can count. Take the risk and try different ways of establishing rapport, of making the human connection.

Let me know how it goes for you.

Cheers,

James

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