The Family Wants It Kept Quiet
Mrs. Helen T., 80, is in your facility for rehab after a hip fracture. She is alert, oriented, and makes her own decisions. At 10 a.m. her son calls the unit and tells you, 'Don't tell my mother her biopsy came back as cancer. We're telling her next week. And please don't let her use the phone today.' At 2 p.m. Mrs. T. asks you directly, 'Did my test results come back? Everyone seems to be hiding something from me.' Later, a man who says he is her nephew calls the nurses' station and asks you what her diagnosis is.
1. How do you answer Mrs. T. when she asks you directly about her results?
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Honestly, without disclosing what you do not have and without lying.
- 'I don't have your results, and I'm not the one who gives them. Your nurse and your doctor will go over them with you. I can see this is worrying you - I'll tell your nurse right now that you're asking.'
- Do not say 'everything's fine,' do not invent a delay, and do not say 'I'm not allowed to talk to you about that,' which confirms there is something to hide and damages trust.
- Do not promise secrecy on the son's behalf. If she asks you to keep her questions private, honor that within your role.
- Follow through the same hour: tell the nurse that Mrs. T. is asking for her results and is distressed, so the conversation happens with the person authorized to have it.
Reasoning: she has capacity, so the information is hers. Your job is to relay the request quickly, not to be the gatekeeper and not to be the one who tells her.
2. What do you say to the son about withholding the diagnosis and about the phone?
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- Acknowledge his fear first: 'It's clear you love your mother and you're trying to protect her.'
- Then be clear about the limits: 'I can't keep her medical information from her - she makes her own decisions, and she's already asking. I also can't stop her from using the phone; her right to call and be called is protected. I'll get the nurse and the social worker so your family can decide together how to have this conversation, and soon, because she's asking today.'
- Do not agree to a plan you cannot keep and do not argue with him about who is right. Route it to the people who can mediate: nurse, social worker, provider.
- Document the request, the time, and that you referred it.
Reasoning: the resident's rights to information and to communication belong to her, not to her son, and an aide who promises to withhold information sets up both a rights violation and a lie.
3. How do you handle the caller who says he is her nephew?
Read the worked answer
- Do not confirm that Mrs. T. is a resident, her room number, her condition, or her diagnosis. Even confirming she is here can be a disclosure.
- Verify identity per facility policy; if you cannot verify, say you cannot give out information over the phone.
- Offer only what policy allows: 'I can take a message and have her nurse or the social worker call you back,' and pass it on.
- If he pushes or becomes insistent, do not argue or negotiate - stay neutral, repeat the offer, and hand it to the nurse.
- Document the call, the request, and the referral.
Reasoning: the obligation is to protect her information, not to satisfy the caller's urgency. Being polite and being closed are not in conflict.