Takeaway
Patients' loved ones enter the room with a lengthy history of how they handle disagreements. When things feel tense, focus on making space for different coping styles rather than trying to resolve long-standing disputes.
Lifelong learning in clinical excellence | March 5, 2026 | 4 min read
By Nettie Reynolds, MDiv, interfaith chaplain
“Illness is experienced within a social world.”
—Arthur Kleinman
The patient’s daughter corrected her brother before he finished speaking. “That’s not what Mom wanted,” she said.
He leaned back in the chair. “You don’t know that.”
By the time I walked into the room, the argument was already underway. No one explained it to me, and no one needed to. The tension was visible in the way they avoided looking at each other.
Challenging family dynamics in patient care
In clinical care, difficult family dynamics can sometimes feel overwhelming. By the time we meet a family, the patterns we see at the bedside have been in the making for years. We meet them in the middle of the story.
My own family’s experience
When my mother entered home hospice in 2020, my sisters and I did our best to provide care. She died of dementia with other co-morbidities, and we had about 10 days together at the end. Those days were full and tender and exhausting because we were trying to care for her while also preparing to lose her.
My siblings and I had different experiences of illness and care prior to our mother’s death. I had worked as a hospice chaplain. One of my sisters was a therapist in private practice. Our mother had raised four strong, independent daughters that showed up at the bedside in the ways we each thought care should go and what we believed Mom would have wanted. We didn’t always handle those differences gracefully.
During those 10 days we alternated shifts so that someone was always there. When it was my turn, I opened the windows and played Buddhist chants softly because I wanted my mother to hear them and feel peaceful. Another sister preferred the curtains drawn, the lights dimmer, and Josh Groban singing “You Raise Me Up.” One of my nieces kept my mom’s nails painted the soft pink color she had loved. None of us knew for certain what she would have chosen, and we were each trying in our own way to make the room feel right for her and bearable for ourselves. It wasn’t that one way was better than another. We were all trying to cope with an unimaginable loss.
Some of our differences showed up in practical ways. One of us wanted detailed clinical explanations every time the nurse was present. Another found those conversations overwhelming and preferred not to go into medical details. Small differences sometimes felt bigger than they were because everything around us felt fragile.
Our whole lives, when something was difficult, we could call our mom and ask what she thought. She was the one who helped us sort things out. During those last days, the one person we would all have called was in the process of dying, and we had to figure things out together without her.
Looking back, it’s clear that no clinician could have resolved our differences, especially in 10 days. No nurse or social worker could have untangled decades of relationships in so short a time. However, the hospice nurses and social workers allowed for our differences and what helped most was their steadiness and willingness to make space for four daughters who loved the same woman in different ways.
Families aren’t blank slates
Families never arrive at the hospital as blank slates. By the time clinicians meet them, patterns of communication and decision-making are already established, and under the pressure of serious illness, those patterns become more visible. Recognizing that families are already deep into their story can make it easier to focus on what’s possible in the time available.
Some conflicts pull at us more than others, and we may feel the urge to take sides or restore order quickly. Recognizing that pull can help us remain steady. And if we feel triggered, sometimes the most helpful step is to pause, take a breath, and/or ask a colleague to step in for a time.
From my years as a hospital chaplain and sitting at my mother’s bedside, a few simple practices have stayed with me:
1. Remember that every family arrives with a long history. We can’t resolve disagreements for them—only they can do that.
2. Offer information in more than one way. Some family members want detailed explanations while others need less. Making room for both approaches can reduce tension.
3. Pay attention to your reactions. When a family dynamic feels especially familiar or difficult, it can help to pause and notice what you’re bringing into the room. That awareness often makes it easier to remain steady and present.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.