Communication Flashcards
Model for Comms SKills
ISPIKES
I- Introduction (Introduce yourself, understand who is the room, ask if they would like anyone else to be there, bring other relevant parties)
S- Setting Up ( Ensure comfortable, ensure someone else for scribing)
P - Perception (Find out what they know, what they’re hoping to achieve from this consultation, what was explained to them prior to any previous procedure/consultation they had)
I - Invitation (Warning shot if there is bad news, Outline structure of consultation, emphasise they’re welcome to ask questions throughout)
K- Knowledge (Deliver the knews in chunks - check for understanding, Elicit concerns throughout, Be honest, Explain what you will do - DATIX, PALS, M&M Meeting, Speak to People)
E - Emotions (Empathy, Difficult questions)
S - Strategy and Summary (Summarise, Explain what actions you will make, Make further meeting if appropriate, Ensure patient has relevant contact details as appropriate)
Cancer + Incontinence post - TURP. 3/12 til FU
Prostate Ca
- Inform of diagnosis
- Next steps (PSA, MRI Prostate, Uro Cancer CNS, MDT)
Incontinence
- Explain this is consequence of TURP
- Plan - PF Muscle therapy, Lifestyle management, Continence Clinic review
Missed Diagnosis
- Apologise. This is not something that should happen and there are mechanisms in place to prevent
- Actions - Datix, Discuss in M&M Meeting, Contact pathology department, Inform consultant in charge of case
Flexi 3 months ago - reported as normal. Flexi today - ?Solid looking tumour
Bladder Cancer Diagnosis:
Break bad news
Next Steps - TURBT, Cancer CNS, Consent for procedure
Missed Diagnosis:
Apologise. Unable to comment on what happened with previous colleague.
Actions - Inform colleague, Discuss at M&M, Inform consultant in charge of clinic, DATIX
Dead Testis 12 year old boy who was seen by colleague a week ago.
Dead Testis:
ORchidectomy + Prosthesis
Discuss - impact on fertility/endocrine dysfunction. Offer that you’ll go through the procedure in more detail later in consultation if time permits
Missed Diagnosis:
Apologise profusely
Explain can’t comment more on what colleague saw as i wasn\t there
Explain that you will ensure the colleague is informed, Consultatn on call is informed, data incident report form is filled, you will arrange follow-up with paediatric consultant going forwards
Rude Relative. Patient in hospital for week due to complicatd lap nephrectomy due to bowel injury (secondary to port insertion). In Ileus now and had peritonitis due to perf. Histology was benign
- Talk with staff about relative - ?Single isolated occurence of rudeness. ANy agression etc.
Ask patient if they would like relative present for consultation.
Bowel Injury
- Risk of procedure
- Steps to prevent - more training, investigate the equipment - ?Safer alternatives,
Ileus / ITU stay (Prolonged recovery):
- Explain bowel injury has caused ileus. Likely to be resolves with conservative measures. Involving the general surgical team for their input on this
- ITU is best place for patient who are unwell post operatively - continue treatment with antibiotics and close monitoring until happy patient is improving
Indication for surgery:
CT Findings indicated cancer
Benign pathology is a risk of any cancer surgery without biopsy beforehand
Severe stent symptoms. Cancelled last case URS + LSF. Patient refusing to leave.
1 Cancellation - Explain reason. Apologise. Explain you will speak to the theatre schedulers to have case re-booked as soon as possible. Explain you will contact patient with updated plan.
- Stent Symptoms - Explain regarding stent symptom management. Hold of urinating as long as possible. Pharmacological treatment - NSAIDs, Tamsulosin, Anticholinergic
- Refusing to go home - Explain that this won’t necessarily help the operation happen sooner. May result in harm - risks of hospital acquired infection,
Flexi: Bladder CA. RIgid Cystoscopy + Biopsy - MIBC. CT - Lung Metastases
Bladder Ca:
Confirm understanding so far. Explain unfortunatley the cancer is muscle invasive and evidence of spread to the lung.
Explain - Not curative, Likely need systemic therapy under oncology team. Have uro CNS with you/family with you. Provide contact details to contact us.
Provide information leaflets - probably won’t remember everything.
Acidentally discharged early from hospital post nephrectomy due to being given incorrect bloods by junior colleague. Now is septic secondary to collection
Sepsis - Explain current diagnosis. Explain necessary steps - antibiotics, drain, inform operating surgeon.
Inappropriate discharge - Apologise. Explain the situation honestly. Explain what you’ll do to make sure this doesn’t happen again in the future (speak to junior colleagues involved, move to electronic handover system, find out more information, add to M&M meeting to discuss, DATIX).
