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What Could Go Wrong? Managing Expectations. Establishing Boundaries

Mrs. Franklin is 87 years old and has several old-age-related health challenges. Although her husband died many years ago, she has lived quite well on her own since then. Her son, Jimmy, lives 800 miles away. She has no other children.

Jimmy Franklin has hired you to be his mother’s advocate; to attend appointments with her, to arrange for her transportation to those appointments, and to provide feedback to him about his mother’s health, including her cognitive abilities. He reports that she’s been forgetful lately. He’s also worried something will happen and if she needs hospitalization, he wants to be sure you’ll be there to advocate for her, at least to stay with her until he can make travel arrangements.

The stage has been set….

What could go wrong? Plenty. Here is an example, and some must-do tasks to go along with it:

It turns out that Mrs. Franklin is a very private woman, and does not like her son meddling in her business. She is appalled that Jimmy knows so much about her condition!  She is upset to think that you might be telling her Jimmy about her health challenges!  (Red Alert! This becomes a trust problem!) She raises the point every time the two of you have a conversation. When you visit the doctor with her, she always looks you in the eye and tells you, “Now don’t you be telling Jimmy the doctor said that!”

But – are you contractually obligated to tell Jimmy because he is the person who pays you?  What does your contract say?  Did Mrs. Franklin sign a contract that says it’s OK to divulge her information to her son?  Are there HIPAA agreements in place? Did Mrs. Franklin agree – but has she now forgotten she agreed you could share information with Jimmy? (Which may indicate Jimmy is right about her ability to remember…)

There are many variables to this scenario, and you’ll want to be sure to protect your practice and yourself by making sure these sorts of issues are documented according to your clients’ wishes – both clients. Managing Jimmy’s expectations, and managing Mrs. Franklin’s expectations about what you can, and can’t contractually say or do is paramount. Maybe they’ll agree that some information can be shared, but not all? Maybe Mrs. Franklin will agree that in an emergency it’s OK to share, but the prescription meds or doctor recommendations will not?  Or?

Further, as time goes on, should Mrs. Franklin question whether you are toeing her line, you’ll want to keep a copy of your contract close at hand so you can show her what you’re using to make the decisions about what to share, or not share, with Jimmy – or anyone else.  Anything you can do to cement trust is very important.

Be very clear both verbally and in writing to be sure you all have the same expectations, and well defined boundaries, or you’ll be asking for trouble for yourself and your practice.


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