Communication Flashcards
How to prepare for a sensitive conversation?
Quiet room - where unlikely to be disturbed
Put bleep/DECT away
Make sure you’re aware of the patient history + current clinical situation
Ask whoever you’re talking to what they know about the situation at present
Before delivering bad news:
Give a warning shot and pause
After giving the news:
Have some silence to let the recipient process things
Consent for Colonoscopy (Risks)
Risks:
Bleeding after tissue sampling - 1/200
Anaesthetic complications
Bowel Perforation requiring an operation - 1/1000
Failure due to inadequate preparation/intolerance
What to say when someone asks when their/their family members operation will be?
Emergency: We are treating this case as an emergency and it is planned for *Insert - Today/As soon as possible*. I’ll check with the team in theatre and either let you know myself or have one of my colleagues or a nurse relay this information
How to close any conversation
“I’d just like to check we have the right contact details”
“If you want to contact myself or the team you can … (usually ask the nurses)”
“Thank you for your time”
i) What does OGD stand for
ii) what should be on the consent form?
iii) Sedated or not?
i) Oesophago- Gastro- Duodenoscopy
ii) Risks:
Sore throat
Bleeding from biopsy
Chest Infection (aspirate)
Teeth damage from endoscope
Tear somewhere in the GI tract - will need an operation (1/1000)
iii) Patient wishes:
- Can have LA (spray) and go home hte same day
with no downtime
- Can have sedation but then will not be able to drive for 24 hours and will need someone to stay with them for 24 hours
Explain Colonoscopy
It is a procedure involving passing a camera, about as wide as a two pence coin, up the back passage to see the bowel. It is very good at picking up any problems with the lining of the bowel and will allow us to take samples for further tests if necessary.
Before:
We also ask that you don’t eat 6 hours before the procedure and only have clear fluids until the procedure itself. You’ll be given a laxative with instructions beforehand too.
During:
The procedure itself usually takes about 30 minutes, but some time will spent explaining things and preparing you. You’ll be sedated throughout the procedure and given pain killer to help you manage.
We may take samples of the bowel wall, this usually doesn’t cause any pain. You may feel like passing wind throughout the procedure and actually do so - this is normal and I don’t want you to be embarassed as most people experience this.
After:
Due to this you won’t be able to drive home and should have someone collect you and stay with you for 24 hours. The sample is sent to a lab to be processed by a specialist. We will then discuss teh findings in a meeting before inviting you to clinic to discuss the matter further. The appointment will probably be 2 weeks after the test itself. It may be nice for you to have someone come along with you to make you feel more comfortable.
I know this is a lot of information so I’ll give you a leaflet explaining this when you leave and give you a contact number if you have any more questions
Jehova’s Witness: What can you do to mitigate against not being able to transfuse them?
Pre-Op:
Check the Hb and decide whether delaying the operation may be better to establish a higher Hb.
Discuss with a haematologist regarding EPO.
If there is time prepare the patient by taking blood and storing it for autologous transfusion later.
Ensure good hydration before the operation
Correct any coagulopathy
Intra-Op:
Experienced surgeon.
Swift Haemostasis.
Cell Saver.
Aggressive fluids if blood is lost
Post-Op:
Adequate hydration.
Regular Hb checks.
Ensure that people are aware not for transfusion.
Mx of Biliary Leak
I understand that there are categories of biliary leak and management differs depending on this. Biliary leaks can be complicated by pleural fistulae/ bronchial fistulae also.
ERCP - +/e Stone removal + stenting + sphincterotomy
Operative - Repair over t-tube, Roux-en-y hepatojejunostomy, Choledochoduodenostomy
