Treating young adult patients who remain tethered to their mothers can be a tricky proposition. The challenge is to develop an appropriate professional relationship with both mother and patient, while maintaining confidentiality and trust.
I have encountered several scenarios. If the mother is someone I relate well to, I risk ignoring the actual patient. George, a shy, introverted young man, likes nothing better than to let his mother handle all communication. Indeed, he refuses to speak with me directly but rather defers to his mother, who texts, emails, and generally acts on his behalf.
But this game of telephone can go awry. As in the actual game, the messages can be transmuted, and I run the risk of making medical decisions based on misinformation. Even his mother sometimes finds the messages confusing. The only solution is for mother and son to meet with me in person, and between appointments, since George refuses to contact me himself, to get both parties on the phone together.
Fortunately, George’s mother is an excellent secretary, transmitting not only medical information but also her son’s appreciation of my kindness and caring. That goes a long way to facilitating his treatment.
A demanding and intrusive mother is more challenging. In my first office visit with one such mother-daughter duo, Mother was so overbearing that I almost asked her to leave the room. Whenever I tried to address Daughter, Mother interrupted, trying my patience. I finally had to request that she keep still.
Not only did Mother interrupt, but she pointedly questioned my diagnosis. A healthy skepticism of a physician’s medical judgment can be useful, but this felt like war. Moreover, in this case, the diagnosis and treatment were obvious. But Mother, wanting to spare her daughter the inconvenience of diet change, kept searching on her smartphone for more convenient options. I found her behavior both distracting and irritating.
When I explained to Daughter as calmly as I could that her condition required following a particular diet, Mother protested. How could Daughter go out with friends if she couldn’t eat what they were eating? Daughter burst into tears.
I must admit, it was very hard to remain cool and calm. Indeed, I had to crank open the window to get some fresh air.
When I took Daughter into the exam room, I finally had some alone time with her. Thankfully, Mother did not attempt to join us. I reassured her that she was young and healthy, and that with the right nutritional program, she would fare quite well.
After the appointment, Mother’s onslaught continued. Seeing her caller ID but not Daughter’s, I did not pick up the phone. As for her emails, I read them and replied directly to the patient.
When Mother’s calls persisted, I came straight out with it. “You are not the patient; your daughter is. She does not need an intermediary. If she has questions, let her address me directly.”
And you know what? Mother was relieved.
Daughter has dedicated herself wholeheartedly to her new diet. Without her mother’s interference, we have developed a good working relationship. She emails or calls with specific questions, and I am happy to answer. In the end, it was worth standing up to Mother.
A situation between these two extremes is a mother whose daughter is not a native English speaker. This mother calls me but is mindful not to overstep her bounds or to interfere with her daughter’s relationship with her doctor. I even find myself reassuring her that her participation in her daughter’s care is perfectly appropriate.
Navigating the shoals of a young adult patient and guardian can be perilous. I find I must chart a unique course for each dyad.
What helps you navigate patient-family relationships? Share your strategies in the comment section.
Marjorie Ordene, MD is an integrative physician practicing in Brooklyn, NY. Her essays, short stories, and poetry have been published in various magazines and anthologies including The Sun, Tablet, Lilith, and Michigan Avenue Review.
All names and identifying information have been modified to protect patient privacy.
Image by artbesouro / Getty