Communication BadNews2013
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Communication Skills in Medicine Tjakra W. Manuaba Dept’ of General Surgery School of Medicine. University of Udayana Sanglah Academic Hospital. Bali
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Transcript of Communication BadNews2013
Communication Skills in MedicineCommunication Skills in Medicine
Tjakra W. Manuaba
Dept’ of General Surgery
School of Medicine. University of Udayana
Sanglah Academic Hospital. Bali
Tjakra W. Manuaba
Dept’ of General Surgery
School of Medicine. University of Udayana
Sanglah Academic Hospital. Bali
“An inquiring, analytical mind;an unquenchable thirst for newknowledge; and a heartfelt compassion for the ailing – theseare prominent traits among thecommitted clinicians who have preserved the passion for medicine
Lois DeBakey
What is Communication
Is the act by which information is shared between humans. Such encounter might cover:
Desires
Needs
Perceptions
Knowledge
Affective states
Is the act by which information is shared between humans. Such encounter might cover:
Desires
Needs
Perceptions
Knowledge
Affective states
The ability to communicate wellThe ability to communicate wellwith patients with patients to build up a to build up atrusting relationship within whichtrusting relationship within whichcuring relieving and comfortingcuring relieving and comfortingcan take place, is a great challengecan take place, is a great challenge
Why good medical communicationWhy good medical communicationis important? is important? better care for ourbetter care for ourpatientspatients
Sir Charles FletcherSir Charles Fletcher
Medical Communcation
Medical communication is the usual communication encounter between doctor and the patient
It can be classified according to the purpose of the interview into 4 types
– History taking
– Consultation
– Obtaining “Informed Consent”
–Breaking bad news
Medical communication is the usual communication encounter between doctor and the patient
It can be classified according to the purpose of the interview into 4 types
– History taking
– Consultation
– Obtaining “Informed Consent”
–Breaking bad news
DOCTORS – PATIENTS RELATIONSHIP.
Not anymore paternalism
Should be partnership basis.
Doctor-Patient collaboration vs health problem
Equal
Not anymore paternalism
Should be partnership basis.
Doctor-Patient collaboration vs health problem
Equal
CommunicationCommunication
To solve problemTo solve problem
To alleviate distressTo alleviate distress
To make DecisionTo make Decision
To form & maintainTo form & maintainrelationshiprelationship
ReassuranceReassurance
To Convey FeelingsTo Convey Feelings
To giveTo giveinformationinformation
To persuadeTo persuade
Communication Purposes (Lloyd & Bor, 1996)Communication Purposes (Lloyd & Bor, 1996)
By Understanding The Whole Process in Medical Communication
BETTER COMMUNICATIONBETTER COMMUNICATION-Clearer Clearer -More effective & efficient communicationMore effective & efficient communication-Honesty & openness.Honesty & openness.-TrustTrust-Mutual respectMutual respect-PolitenessPoliteness-AdherenceAdherence-Collaboration.Collaboration.-More accurate informationMore accurate information-Prevention of violent situationPrevention of violent situation-Informed consentInformed consent-Legal aspectsLegal aspects
Bad News
Inevitable part of medical practice
Not widely taught in medical schools
Studies how patients/ families cope with bad news “not the process of breaking bad news”
Bad news is a relative concept & should depend on patient’s interpretation of information & their reaction to it where patients feel the news will adversely affect their future
Inevitable part of medical practice
Not widely taught in medical schools
Studies how patients/ families cope with bad news “not the process of breaking bad news”
Bad news is a relative concept & should depend on patient’s interpretation of information & their reaction to it where patients feel the news will adversely affect their future
BREAKING BAD NEWS….BREAKING BAD NEWS….
CONDITIONINGPLANNINGEXPLANATION
Conditioning…familiesstep by step….
Family learns to accept the bad situation
Why is it difficult to break “bad News”
The messenger may feel responsible and fears being blamed
Not knowing how best to do it
Possible inhibition because of personal experience of loss
Reluctance to change the existing “doctor-patient relationship”
Fear of upsetting the patient’s existing family roles/ structure
Not knowing the patient, their resources & limitation
Fear of the implications for the patient (disfigurement, pain, social and financial losses)
Fear of the patient’s emotional reaction
Uncertainty as to what may happen next and not having answers to some questions
Lack of clarity about one’s own role as a health care provider
Lloyd and Bor, 1996
The messenger may feel responsible and fears being blamed
Not knowing how best to do it
Possible inhibition because of personal experience of loss
Reluctance to change the existing “doctor-patient relationship”
Fear of upsetting the patient’s existing family roles/ structure
Not knowing the patient, their resources & limitation
Fear of the implications for the patient (disfigurement, pain, social and financial losses)
Fear of the patient’s emotional reaction
Uncertainty as to what may happen next and not having answers to some questions
Lack of clarity about one’s own role as a health care provider
Lloyd and Bor, 1996
Managing difficult situation in breaking bad news
To whom should bad news be given
Who should give bad news
When should bad news be given
How much bad news should be given
Should you give hope and reassurance along with bad news
To whom should bad news be given
Who should give bad news
When should bad news be given
How much bad news should be given
Should you give hope and reassurance along with bad news
How to give “bad news”
Personal preparation
The Physical Setting
Talking to patient and responding to concerns
Arranging for follow-up or referral
Feed and handover to colleagues
Personal preparation
The Physical Setting
Talking to patient and responding to concerns
Arranging for follow-up or referral
Feed and handover to colleagues
KEY CORE SKILL FOR BREAKING BAD NEWSEXPLANATION & PLANNING.
Preparation
Summarizing
Negotiating the Agenda
Listening
Picking up Cues
The use of Silence
Discovering the patient’s concern and ideas
Encouraging the expression of feeling
Picking up the non verbal cues
Preparation
Summarizing
Negotiating the Agenda
Listening
Picking up Cues
The use of Silence
Discovering the patient’s concern and ideas
Encouraging the expression of feeling
Picking up the non verbal cues
ConclusionsConclusions
Doctors do need communication skill
If Doctors have more times, “bad news” should be given “step by step” by “conditioning” patients and family
Doctors should convey “bad news” without delay
“Bad News” should be carefully and systematically “prepare”, by learning the background of the patient and family
Doctors do need communication skill
If Doctors have more times, “bad news” should be given “step by step” by “conditioning” patients and family
Doctors should convey “bad news” without delay
“Bad News” should be carefully and systematically “prepare”, by learning the background of the patient and family
Thank youThank you
