Difficult Conversation

Question 1

Structure

Answer 1

Chairs at 90 degrees
Introduction

Gather information: open questions, respond to cues

Psychosocial information

• Ideas
• Concerns - physical, social - who can you talk to? who is at home with you? psychological (coping? mood?)
• Expectations - hidden agenda?

Explanation/reassurance
- Check understanding

Management options

• Suggest solutions
• Give them the choice

Plan

• Help options
• Who can they talk to
• Follow up appointment/meeting
• Leaflet

Summary
- Any questions

Question 2

KEY

Answer 2

EMPATHISE
USE PATIENTS NAME
RESPOND TO CUES - comment - you look worried - repeat it back and ask more
ARRANGE TO MEET TO DISCUSS AGAIN

Question 3

Patient concerned about test

Answer 3

Find underlying reason for concern

Question 4

Patient wants sick note because of problems at work

Answer 4

Bullying?

Question 5

Patient wants to die

Answer 5

Reasons
Though about how they would do it
Bio/psycho/socia/financial

Protective factors

Question 6

Relative: carer struggling

Answer 6

Social services carer assessment to provide money/respite/help
Charities e.g. carersuk.org and carerssupport.org - help groups and support groups - not alone
Health visitor for children
Stress they are not alone

Question 7

Relative concerned about social care arrangements for elderly relative

Answer 7

Social services can arrange care
Private care organisations
Rapid response team for short term care in crisis

Question 8

Relative - patient has stopped taking medication

Answer 8

?

Question 9

Colleague - another team member is not pulling weight

Answer 9

Speak to culprit directly

Consider speaking to senior - offer to be present

Question 10

Colleague - being bullied

Answer 10

Could they approach the perpetrator
Speak to supervisor/senior/human resources
Offer to be present

Have they tried to resolve it?
Formal complaint
Screen for depression

Question 11

Colleague - issues at home affecting work

Answer 11

Who can they talk to
Supervisors - clinical/educational
Senior
HR
Talk to GP
Counselling services

Question 12

Colleague - shaken up by event

Answer 12

Ongoing support
Speak to supervisor, occupational health
Offer to be present

Question 13

Colleague- made a mistake

Answer 13

Non-judgemental attitude
No blame cuture
Incident reporting can help so that others can learn from mistake and it doesn’t happen again
Honesty is best policy

Question 14

At the end

Answer 14

Thank you for sharing with me and for being understanding
Important to understand how you feel so we can work together to help you

Anything else I can do to help

Go over plan and strategy to deal with feelings and review