Where the competent patient approves of their involvement or where the incompetent patient relies on them as surrogate decision-makers, there are reasons for exerting efforts to avoid the alienation of these individuals from the medical interaction. They can help to promote the patient's welfare, both as advocates of a patient they know well and as potential allies to the provider. A physician who works in collaboration with difficult family members sends the message that he or she values their perspective as one that furthers the overall commitment to the patient's well-being that both parties share. A gesture that recognizes contributions others have to offer is a first step toward building a relationship of trust, a lack of which is a plausible explanation for difficult behavior in the first place. Distrust is only one of many possibilities why families might seem uncooperative.
Communication plays a significant role in the process.
Talking to families openly and exploring recommendations, alternatives and their respective justifications are exchanges that can clarify a patient's and a physician's motivation for preferring a certain course of action. Such dialogue is likely to cut, if not eliminate, unreasonable behavior. Only in situations where good faith attempts to work with difficult relatives are ineffective and where their behavior compromises patient welfare should they be excluded from the medical encounter. Rather than become impatient or dismissive with a family member who repeatedly second-guesses medical recommendations with information from the Internet, the physician should try to identify some reasons for the behavior. Some likely explanations are that the relative is reacting to a loss of control, distrust toward the physician or the desire to understand the patient's condition and the physician's recommendations in more depth.