Off the Record
We were treating a patient for several weeks and making some progress toward her discharge. There was a family conference and it was decided, with the patient's input, that she'd go back to her apartment. For the next couple of days, she seemed not to care where she went to live despite our encouragement.
When a family member cornered me, we spoke about the patient's progress and the decision about having her go back to her own apartment. Then the family member said, "Off the record, how do you think she is really doing?"
I've been in therapy long enough to know there is no such thing as "off the record" when it comes to family and what we say to them. So I played diplomat and said very little regarding what I thought. I stuck to the objective data of how the patient was doing with therapy and the decision about going back home. I could have told this family member to leave the patient where she was for another month to get stronger but I thought the patient may have wanted to go home and money was an issue. I suspected the patient was withdrawing so she didn't have to make the tough decisions about whether to go home or to stay. She probably would have accepted either decision as long as she didn't have to make it.
There's also the detail of what the patient tells me versus what she tells the family. Sometimes it's two completely different things. When this happens, I turn it over to the people in charge and allow them to haggle over the details of where the patient wants to go. My job is to do therapy and see that the patient gets stronger to function more independently.
What do families expect from us? Should we tell them their mom is a pain to work with and please take her home immediately because everyone is sick of her? No. We present our data as objectively as possible and based on this input, the families can make the final decision. There should be no "off-the-record" patient progress; everything we do in therapy should reflect how well the patient is doing functionally and how much assistance the person needs to attain the independence she's striving for.