You’re sitting in the hospital bed.

The doctor walks into the room, looks at your daughter and asks:

“How has she been feeling?”

Your daughter answers.

“Has she been eating?”

Your daughter answers again.

“Has she been confused at home?”

Another answer.

And you’re thinking:

I’m sitting right here. Why doesn’t anyone ask me?

It happens more often than people realize.

Sometimes there’s a good reason a family member or caregiver needs to help with the conversation.

But needing help doesn’t mean the patient should disappear from it.

How Does This Happen?

Most of the time, I don’t think anyone deliberately decides to ignore the patient.

Healthcare moves quickly.

A family member may know the medication list.

They may have important information about what has been happening at home.

They may answer questions faster.

The patient may be tired, hard of hearing or struggling to remember details.

So gradually, almost without anyone noticing, the conversation shifts.

The healthcare provider asks the family.

The family answers.

And the patient becomes the person everyone is talking about rather than the person everyone is talking to.

Older Doesn’t Mean Unable to Answer

This is an assumption we need to be careful about.

A person can be 85 years old and perfectly capable of answering questions about their own health.

They may answer more slowly.

They may need you to speak louder.

They may need their glasses or hearing aids.

They may need a question repeated or explained differently.

None of those things automatically mean they can’t participate.

Sometimes healthcare professionals—and families—are trying to save time.

But taking an extra moment to let someone answer for themselves isn’t wasted time.

It’s respect.

Cognitive Changes Don’t Erase the Person Either

This becomes more complicated when someone has dementia, delirium or another condition affecting thinking and memory.

Family input may become essential.

A daughter may know that Dad normally dresses himself but suddenly can’t figure out how to put on his shirt.

A spouse may recognize that the confusion we’re seeing in the hospital is completely different from the patient’s usual behavior.

We need that information.

But even when a patient cannot answer every question reliably, we can still include them.

“Mr. Jones, how are you feeling this morning?”

Then, if necessary:

“Susan, is that what you’ve been noticing at home too?”

It is a small difference.

But to the person in the bed, it may be an enormous one.

Families Can Accidentally Do It Too

This isn’t only a healthcare-provider issue.

Families sometimes answer before the patient gets the chance.

Doctor: “Are you having any pain?”

Daughter: “She’s always complaining about her back.”

Maybe Mom was about to say something different.

If you’re accompanying someone to an appointment, give them a moment.

Let the healthcare provider ask them.

Let them answer what they can.

Then add what you know.

Being an advocate doesn’t always mean speaking for someone.

Sometimes it means making sure they have enough room to speak for themselves.

Talk to Me, Not Over Me

There are little things healthcare professionals can do that make a tremendous difference.

Make eye contact with the patient.

Introduce yourself to them first.

Ask the patient the question before turning to the caregiver.

Explain the procedure to the person who is actually going to experience it.

Don’t automatically use childish language because someone is older.

Don’t refer to someone as “Mom” or “Dad” simply because that’s what the family calls them.

And if the patient needs communication support, find out what helps.

Maybe they need their hearing aids.

Maybe they need an interpreter.

Maybe they need written information.

Maybe they simply need more time.

Patients Can Bring Themselves Back Into the Conversation

It can be intimidating to interrupt a doctor, nurse or even your own family.

But if you feel yourself disappearing from the conversation, it’s okay to say:

“I’d like you to ask me first.”

Or:

“My daughter can help, but I’d like to answer what I can.”

Or simply:

“I’m right here.”

That isn’t rude.

It’s your healthcare.

You belong in the conversation.

Caregivers Still Matter

None of this means family members should be pushed aside.

Quite the opposite.

A good caregiver can provide information that changes care.

They may notice subtle changes.

They may remember details the patient forgot.

They may ask the question the patient was too overwhelmed to think of.

The best healthcare conversations aren’t patient or family.

They’re patient and family when the patient wants family involved.

But there should always be an awareness of whose body, illness and life we’re discussing.

Never Forget the Person in the Bed

After decades at the bedside, one thing becomes very clear.

Illness takes enough away from people already.

Privacy.

Routine.

Independence.

Control.

Sometimes even the clothes they walked in wearing.

We don’t need to take away their voice too.

There will absolutely be times when a healthcare professional needs information from someone else.

There will be patients who cannot speak for themselves.

There will be difficult situations where families become an essential part of communication and decision-making.

But whenever the patient can participate, make room for them.

Look at them.

Ask them.

Wait for the answer.

Include the people who love them without allowing those voices to replace theirs.

Because the patient isn’t simply the subject of the conversation.

They’re the reason we’re having it.

References

The Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care.

Agency for Healthcare Research and Quality. Guide to Patient and Family Engagement in Hospital Quality and Safety.

Centers for Medicare & Medicaid Services. Hospital Patient Rights.

National Institute on Aging. Talking With Your Doctor.

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