Station 2 - Challenging Interaction - The Fall Flashcards
How to deliver bad news
Follow SPIKE protocol
S - Setting: Arrange for a suitable setting. This means ensuring privacy, eliminating interruptions, and making the environment comfortable. I would also ensure that any significant others, like family or close friends (with the patient’s consent), are present as they can provide emotional support and help remember information
P - Perception: I would first assess the patient’s perception of their situation. This will help me gauge their understanding and expectations. For instance, I might ask, “Could you tell me how you’ve been feeling lately?” or “What have your main concerns been about your illness?”
I - Invitation: It is crucial to ask the patient’s permission before delivering bad news. Some patients may prefer not to know all the details. An example could be, “I have your test results - would it be alright if we discussed them now?” followed by “unfortunately I do have some bad news.”
K - Knowledge: Use simple language, free of medical jargon. I would aim to be honest, but also sensitive, giving information in a gentle yet straightforward manner. Checking the patient understands every step along the way.
E - Emotion and Empathy: After delivery, it’s critical to respond to the patient’s emotions empathetically. This may involve acknowledging their feelings, offering comfort, and validating their emotions. For instance, I might say, “I can understand this isn’t what you were hoping to hear. It’s completely natural to feel upset.”
S - Strategy and Summary: Finally, I would outline the next steps, whether it’s further diagnostic tests, treatment options, or referral to a specialist. Summarising the plan provides a way forward and helps ensure the patient fully understands
How to deal with a fall
SOCRATES
1) S - Site - Where they are experiencing pain, could be specific areas like the hip, wrist or back
2) O - Onset - Inquire when the pain started. Was it sudden at the time of the fall, did it develop gradually afterward?
3) C- Character - ask the patient to describe the nature of the pain. Is it sharp, dull. throbbing or stabbing?
4) R - Radiation - Has the pain spread to other areas
5) A - Associations - Any associated symptoms. Have you experienced any swelling, bruising dizziness, lost of consciousness, vomiting?
6) T - Time Course - Has the pain been constant since the fall or does it fluctuate in intensity?
7) E - Exacerbating - Do any actions that make it work or alleviate the pain
8) S - Severity - On a scale of 0 to 10, can you rate the pain? 0 being no pain and 10 being the worst pain
How to deal with an angry patient
I can see that you’re upset, I’m here to help
