Family meetings are common in healthcare settings and are organised to convey a point of view or to try to bring together disparate points of view. These events may be the first chance that some of the key stakeholders, i.e. the family and the healthcare team, have to meet each other. 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. To establish a trusting therapeutic relationship between the patient, their family and the healthcare 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 sat down on the floor in a cross-legged position and the rest of his family followed.
While dropping to the floor and re-arranging my legs into a well-versed pose, “I’m an Islander too, and I’m used to sitting on the floor too.” I was joined by my cross-legged team member. Eyes were in contact and were levelled, as were some of the power differentials. Serious issues were discussed in a different but more trusting fashion.
We are indoctrinated into doing things inside set processes of actions. This may 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 different people with varying agendas, the establishment of rapport must occur in the first fifteen seconds. Otherwise, the participants may not be present at 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 our seat is on the floor.
Trying to meet people at their level, trying to make a human connection. How does that fit in with maintaining professional boundaries and professional distance? Or are these self-protective mechanisms barriers to being present in the clinical moment? If boundaries get blurred too much, does that expose the clinician to a 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 different to our views. Can the twain of disparate agendas be brought into the 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, 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 some of the light will flow back in to enrich the shared experience of care. Though we do not love their loved ones, we care and need to show it. 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.
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