Challenging Interactions

Question 1

Why are they bad? (3)

Answer 1

Take up time and resources
Emotionally draining and contribute to stress/anxiety in doctors
Affect healthcare decisions + cause mistakes

Question 2

What are the staff/doctor factors contributing?

Answer 2

HALT = hungry, angry, late, tired

Burnout/fatigue, distraction, junior

Question 3

Patient factors contributing

Answer 3

Personality, attitudes, illness behaviours, culture

Question 4

Illness factors contributing

Answer 4

Clinical complexity, whether treatable, whether chronic

Question 5

System factors contributing

Answer 5

Economic, health care system, isolation, relationships

Question 6

What is transference?

Answer 6

Unconscious transfer of emotions + attitudes to a person/situation in the past to a person/situation in the present

Question 7

What is counter-transference?

Answer 7

Responses that is elicited by the patients unconscious communications, which is conscious + focuses on thoughts and feelings

Question 8

What is BATHE?

Answer 8

B = background - what is going on in your life at the moment?
A = affect - how are you feeling about that?
T = trouble - what troubles you most about this?
H = handling - how are you handling this?
E = empathy - that must be very difficult for you

Question 9

What is REBELS?

Answer 9

R = recognise the problem
E = express empathy
B = est. clear boundaries - "we have a practice policy", "legally I am not able to sign that until I have more information"
E = emphasis patient's best interest - "its really important we get this sorted for you"
L = inclusive language - we, both, us
S = focus on solutions - move from problem, to needs, to solutions e.g. "I am unable to \_\_\_\_, but it is important we sort \_\_\_\_\_\_, so why dont we try \_\_\_\_\_\_"