Building relationships with patients and their families: the consultant in rehabilitation medicine

During her core medical training, a rehabilitation medicine consultant came to assess a patient that Meenakshi Nayar was caring for, inspiring her with his holistic, patient centred approach.

“The consultant considered the whole patient in his assessment, which really caught my interest,” says Nayar, now a consultant in rehabilitation medicine and clinical lead for the Charing Cross Neurological Rehabilitation Unit in London.

“On an acute medical ward, it was mainly about making sure the patient was managed safely and medically stable, so this approach, which meant looking to the future and looking at what it means for the patient to have this disability, felt very different.”

When working with junior doctors and medical students Nayar encourages them to find and follow their passion in medicine, as she has done. “Having a passion for something really helps you be happy at work and gives you more joy,” she says. For Nayar, who was born in India and grew up in Doncaster, this meant the small specialty of rehabilitation medicine. She quickly knew she had found the right area to focus on. “From day one, I felt like I was home,” she says. “I love having time to get to know our patients, as they tend to stay with us for a few weeks. We build a relationship with the patient, but also their family and loved ones.”

Doctors in rehabilitation medicine specialise in improving people’s function and supporting them to be as independent as possible following illness or injury. Nayar’s subspecialty is neurological rehabilitation, treating people with complex problems resulting from brain injuries, spinal cord injuries, or peripheral nerve injuries. This could be a stroke, a spinal cord injury after a fall, or a brain injury after a traffic incident. “There is a huge variety of what patients can present with but, in general, our patients tend to have a combination of physical, cognitive, and communication impairments,” she says.

As a smaller specialty, there are strong support networks between doctors and a truly multidisciplinary approach to get the best outcomes for patients, Nayar says.

She has strong memories of when senior doctors helped those early in their careers. There was the lecturer at medical school who hosted gatherings for students, for example, and there was the time she was included in a staff social event on her first placement as a foundation doctor, where the senior house officer paid for her meal. “It was fifteen years ago, but the profound impact of that generosity has stayed with me,” she says.

Nayar emulates this by giving her time to those she mentors and making sure she is available when they need her. Trying to provide consistency helps too, she says. “Lots of change didn’t help me. So having the same supervisor, or being attached to a firm so you can have some kind of belonging, is really helpful.”

Creating the right culture in clinical areas benefits staff and patients, she adds. “My ethos is to be open and honest.”

“If people have challenging things happen at home, that’s part of life, and it’s beneficial if you can bring your whole self to work,” Nayar says. “You don’t necessarily have to share everything you’re going through, but it can help if there are people to talk to.”

In a practical sense, this involves making time to catch up with mentees and colleagues. “It might be having coffee together, or having a short chat before a ward round,” Nayar says. “I try to have lunch with my team at least once a week, so that we’re all together. But it’s also about following up with people, for example, if someone has told you something that’s happening to them. It’s just what you would do with anyone that you care about, and it’s important to care about your team.”