Seven types of family you will encounter in the ICU settings

Communicating with the patient’s family is a very important part of my job. Updating the family and making decisions on the medical care for their loved one is as important as seeing the patients and performing the procedures. Talking to the family, sometimes, takes time. It could also be challenging or even frustrating as well. Over the years I have identified several types of families. Each type of the family requires a different approach and presents it’s own challenges.

Average Family.
This is, fortunately, the most common type of the family. It’s easy to communicate with the family members. They are readily available by person or by phone if I have a question or need to get a consent for a procedure. The expectations on the outcome are usually reasonable. The family members are friendly and ask the appropriate questions.

Overbearing Family .
Every time you come into the patient’s room there will be five or so relatives at the bedside. Some will be constantly readjusting the blankets or yelling at the otherwise unresponsive patient “Wake up, wake up, Dad”. Often we ask the family to step out of the room so that the patient can get some rest. If you have a family conference there will at least one family member writing down every single word you say.
Outside of the overbearing nature of this kind of the family, dealing with it is usually easy. You might need to spend some extra time with the family and maybe answer a few extra questions. The expectations, otherwise, are quite reasonable and the decisions are being made in a timely manner.

Paranoid Family
This is the most difficult type of family to deal with. Everything you say or do will be taken with a suspicion. The questions that this family asks are often “off the wall” and have nothing to do with the patient’s condition. There is always somebody with a “medical background” generating controversy and conflict behavior towards healthcare providers. (One time this medical expert was a dental hygienist from three states away).
The family conference with this family will be extremely painful and you will feel like the life was sucked out of you by the time you done talking to them.

Psychotic family.
This is another “challenging” type of the family. Fortunately, this is quite rare. Severe dysfunction, substance abuse, psychiatric illness and domestic violence are often rampant in this family. The threats of a lawsuit or even physical damage are not uncommon. If I have a family meeting, I never let anybody block the exit and I always have a witness in the room.

Religious Family
There is nothing wrong with being religious as long as this is not altering your common sense and the perception of reality. I have no problems with letting families perform some religious ceremonies in the room (like sprinkling with a holy water) as long as there is no harm to the patient and it does not interfere with the care. You will identify this kind of family if you get a response beginning with “I believe in Lord Jesus Christ….” To most of you questions and requests.

Absentee Family
This simply happens when the family is not around. The communication is difficult since you have to negotiate everything over the phone.

Indifferent family
The family members simply do not care. Once I heard from the mother of one of my patients: “Do not call me unless he dies. He was never a good son.” This is also rare, but it happens. This is very, very sad too.