This was my first week on my general neurology rotations. In addition to encountering the always fascinating variety of neuropathophysiology ,this was a week that firmly underscored how important personal relationships continue to be to the work of caring for patients. Various aspects of this reality were all centered into a single case.
The first point was regarding the potential impact we can have in shaping the course of care of our non-physician friends and families. In this case the family of a patient who were originally happy with her care at another institution suddenly due to the advice and criticism of a family friend who is a healthcare professional, became extremely aggressive in pursuing a somewhat logistically irregular transfer to our service. The role of personal connection here is very clear. While we are often reminded of the power dynamic between our patients and us in the normal courses of our work, it is less common to reflect upon this same information disparity within our families and social networks. At the same time, this type of personal connection can complicate issues and potentially undermine a loved one’s actual caregivers to an extent they can also contribute towards resolving them. We were only able to get a clear sense of the situation involving the transfer because one of my residents was able to reach out to his friends at the sending institution to clarify vital points. It was with this information that we felt confident that the transfer was irregular and almost certainly not warranted. A further relationship-based issue surrounding this case in maintaining professional respect between attending physicians and institutions. In this case, the sending attending institution seemed to largely attempt to circumvent the proper channels and show the appropriate respect to the team most likely to ultimately take over the patient’s care. This case also demonstrates one further potential downside of having close personal relationships within your field. As we grew more frustrated about the transfer and were increasingly certain that it did not meet appropriate standards in the absence of a reciprocal agreement, we noticed that a resident on the sending team was the brother of an attending at our institution. This resulted in a misunderstanding regarding motivations and why certain steps were taken which was unfair to them as neither was involved in any dubious way. While this was ultimately resolved, it does demonstrate how such coincidences can happen particularly between family members working in the same specialty.