Hands on/hands off: Why health care professionals depend on families but keep them at arm's length

In the theater the fictional Dr. Kelekian's relief that he does not have to talk to family members about his patient's cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.

Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as "trouble"? And why do families so often see medical professionals as uncaring and uncommunicative? Presumably everyone wants the same goal-recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of "dysfunctional families" or "callous doctors," although there are undoubtedly many of each. Rather, we see the problem as deriving from fundamentally different views of the patient's identity and from the special, sometimes conflicting roles that both professionals and family members play in the patient's care. Increasingly, the structure and practices of the health care system is forcing these should-be partners into adversarial positions.