Comms 6 (Difficult) Flashcards
What is breaking bad news?
Telling the patient something that they don’t want to hear.
- That something is wrong
- That something isn’t wrong (normal blood tests)
What is empathy?
The ability to understand and share the feelings of another
What is key to breaking bad news well?
Honesty
Meeting the patients need for information
Don’t guess at prognosis or offer empty platitudes
Don’t remove all hope
Confidentiality remains crucial
Revisit the bad news
What are some useful techniques in breaking bad news?
Think about how it will affect the patient
Try to establish what they want to know at this point
Be sensitive not blunt
Ensure that they have time – don’t deliver and dash!
Let the patient lead on prognosis questions
Watch for denial but don’t destroy it
Don’t get involved in conspiracy of silence
Use plain English
Revisit questions over time and keep seeking understanding
What basics should we use to help the conversation in breaking bad news?
Privacy Open layout of the room Enough time Ask if they want somebody there Appropriate body language Give warning shot Pause to allow them to process Revisit - tell me what you understand Is there anyone you'd like me to call?
What are the different types of three-way conversation?
Parent and dependent child Patient and spouse Child and elderly parent Family translator Carer and disabled patient (broadest sense)
What are the key considerations in a consultation with a parent and a dependent child?
Consent and understanding Parental anxiety Engaging child – its their consultation Manage all parties ICE Remember your responsibility to confidentiality and the child Never forget safeguarding
What are the key considerations in a consultation with a child and an elderly parent?
Adult safeguarding
Child anxiety of risk to elderly family member
Engaging patient –its their consultation
Manage all parties ICE
Remember your responsibility to confidentiality
What are the key considerations in a consultation with a patient and their spouse?
Adult safeguarding Confidentiality Engaging patient –its their consultation Manage all parties ICE Watch for the “dominant other” may never establish the true issue
What are the key considerations in a consultation with a parent and a family translator?
Confidentiality Engaging patient –its their consultation Carefully watch body language Consider second formal translator consultation where concerns exist Watch for possible safeguarding issues
What are the problems with translator conversations?
Loss of direct engagement
Loss of verbal cues
Much harder to use humour or mirror emotion
Take longer
Generally mean potential cultural challenges
Often on phone meaning cannot pick up translator reactions
What are the problems with using a family/friend as a translator?
Are you getting the true story? Whose history is it? Confidentiality cannot be maintained Be aware of safeguarding risks Difficult to be sure what you say is what’s being passed on
When might you use a telephone consultation?
Becoming increasingly common When the patient cannot get into the surgery - physically or because they are working Communicate test results Give advice Follow up from an appointment
What are the problems with a telephone consultation?
You only have history
No visual cues only verbal
Can’t examine the patient
Your risk management strategies have to be better
How can we manage angry patients?
Remember being ill can make you angry
If we feel angry the patient probably does
Anger can occur when there is a mismatch in ours and our patients expectations
Its not you who is angry so don’t go there
Explore the anger
Apologise – its not an admission of guilt
Don’t accept aggression in the workplace
