Physicians as Caregivers, A Powerful Position

04 Jun 2021

By Erin King-Mullins 

What do you do when you are a physician and your loved one falls ill? It’s a paralyzing feeling to have someone you love hospitalized when you can’t direct their care, especially when the issue falls within your realm of expertise. The phrases ‘well, the way we do it’ and ‘the latest guidelines say’ circle your brain constantly. Sit back, take a breath, and be a caregiver, not a provider.

A caregiver has a very important role, so don’t underestimate the impact you can have. The ability to interpret for both sides puts you in a position of great power to influence your loved one’s outcome. Think about it. As a physician, you are responsible for listening to your patient and, hopefully, appropriately absorbing their message and meaning. You then have to synthesize that information to formulate a differential diagnosis, share it with the patient, and create an evaluation and management plan. As a physician-caregiver, you can ensure the messages relayed from patient to physician and vice versa are as accurate as possible. Your family can then make the most informed and educated decision with your guidance, knowing you only have their best interests in mind, and the care team can understand the family’s goals of care.

Recently, my sister took my father to the hospital with shortness of breath. He’s 86 years old. He has a longstanding (>10 year) history of hyponatremia for which he takes salt tabs daily. He has a more recent, approximately 6 month, history of idiopathic hypoglycemia for which we make sure he snacks frequently. On admission to the hospital, a pleural effusion was diagnosed which was new compared to a previous scan about 6 months ago. There was a concern for a need for thoracentesis, and the prospect of intubation was even raised. He was admitted to the ICU. Everyone was flustered and chasing the blood glucose and sodium. More than 24 hours passed and he had still not seen a pulmonologist. He still complained of SOB. Meanwhile, no one had consulted the family, and they never talked to the 86 year old patient because what does he know?

While my other sister, an OB-GYN, was present, the intensivist made rounds. We were all on video chat. Among other things the intensivist says, “Well, we didn’t know if there was any dementia involved or if he would need a feeding tube….”

Have you talked to the patient or family?! My dad is quite sharp and can more than speak to the fact that his sodium and blood sugars run low. We as a family have a great handle on his medications and medical problems. WE ARE HERE FOR HIS BREATHING. We assert that we are here as family first, so as to not offend, but intend to play an active role in appropriately guiding his care.

We were fortunate to be able to advocate fiercely for our father given he has two physician daughters. Doctors have immense power in caring for our loved ones despite not being their physician of record. Caregivers have a lot to offer, and we should cherish the ability to do just that.

Here is what not to do:

– Don’t get ‘paralysis by analysis’. Have those hard talks with your family members about end of life so you can ensure that their wishes and bodies are respected.

– Don’t make decisions for them.

– Don’t get upset when you feel like they are making the ‘wrong decision’. Physicians must respect patient autonomy, this includes our own family.

Equip your loved ones the best that you can with the knowledge you have. At the end of the day, it’s about caring for the patient. Our egos have to be checked at the door, just the same as if we are caring for any patient.

Dr. Erin King-Mullins graduated summa cum laude from Xavier University in Louisiana. She received her medical degree from Emory University in Atlanta, then completed her internship and residency in general surgery at the Orlando Regional Medical Center in Florida. Dr. King-Mullins went on to complete her fellowship in colorectal surgery at Georgia Colon & Rectal Surgical Associates and subsequently joined the practice, currently serving as faculty/research. She treats all colorectal conditions and has a special interest in minimally invasive robotic surgery and anal cancer prevention in high-risk women. She is a fellow of the American College of Surgeons and the American Society of Colon and Rectal Surgeons, where she serves as the inaugural Chair of the Diversity, Equity, and Inclusion Committee. You can follow her on Twitter @eking719.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.