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Communicating sensitive information to the patient

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Communicating sensitive information to the patient by Kavya Kurkal

Communicating sensitive information to the patient by Kavya Kurkal

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  • 1. CONVEYING SENSITIVE INFORMATION TO THE PATIENT AND THE FAMILY
    KavyaKurkal
    Seth GS Medical College
  • 2. WHAT NOT TO DO
  • 3. 6 STEP PROTOCOL
    Getting started
    What does the patient know?
    How much does the patient want to know?
    Sharing the information
    Responding to patient and family feelings
    Planning and follow up
    Taken from ‘ How to Break Bad News: A Guide for Health Care Professionals’ by Robert Buckman
  • 4. DEATH
  • 5.
  • 6. WHY?
    For the benefit of the patient’s family and friends
  • 7. For the benefit of the doctor
  • 8. For the benefit of the medical student
  • 9. HOW?
    Here are a few basic steps to follow:
    PREPARATION
    • Should know the history of the case
    • 10. Should be able to explain in simple terms
    • 11. Should be armed with answers to all possible questions
    • 12. Should remain calm and composed
    • 13. Should not appear impersonal or disinterested
  • METHODS:There are two methods available:
    Telephonically
    In Person
  • 14. CONDITION UPDATES:
    • Many families express anger and feelings of helplessness
    • 15. Keep family updated during resuscitation
    • 16. Balance the needs of the patient and family
  • RESPONSIBILTY OF COMMUNICATING DEATH
    I
    t is the responsibility of the physician who has been treating the patient and this responsibility should not be delegated to anyone else unless absolutely necessary.
    WHEN IS THE ‘RIGHT’ TIME?
    There is no such thing as the ‘perfect’ moment.Try to break it down gently . Do not be in a hurry or abrupt.
  • 17. MANNER OF CONVEYANCE
    • Medical facts are less important than compassion
    • 18. Do not go into the technical details
    • 19. Give them time and space
    • 20. It is their right to ask as many questions as they want
    • 21. It is left to the discretion of the doctor as to how much information to divulge and to maintain a balance
    • 22. Try to inform all the family members in a group
  • FAMILY REACTION
    GUILT
    SORROW
    DENIAL
    ANGER
    ACCEPTANCE
    DEPRESSION
  • 23. VIEWING THE BODY
    • Necessary evil
    • 24. Prepare the body
    • 25. Families of mutilated patients should be warned
    • 26. Viewing can done individually or in a group privately
    • 27. If patient is a child, wrap in blanket and give parents opportunity to hold child
  • CONCLUDING THE PROCESS
    Effective communication continues beyond this as there are a few issues left to be dealt with by the family. The family members should be encouraged to contact the doctor if any queries arise.
    • Mortuary
    • 28. Autopsy
    • 29. Tissue and organ donation
    Let the family know that they can stay at the hospital for as long as they want
  • 30. DEATH OF A CHILD
    It is a particularly sensitive situation.
    • Give parents enough time to hold child
    • 31. Religious preferences and ceremonies
    • 32. Information to nursing mothers
    • 33. Informing the child’s sibling
    • 34. Offer to preserve momentos
  • RED FLAG SIGNS
  • 35. AFTER DEATH
    • The practice of using the newly dead for the purpose of medical research and advancement has met with increasing controversy
    • 36. Problems of disclosure and informed consent
    • 37. Difficult to approach a grieving family
    • 38. Other ethical issues arise from cultural differences in treating the body of the newly dead
    • 39. Currently no universal guidelines or official policies regarding this practice exist.
  • ROLE OF THE MEDICAL STUDENT
    • Importance of providing appropriate and adequate training to medical students in patient communication
    • 40. Students should be allowed to accompany the physician while disclosing sensitive information
    • 41. Students should be encouraged to discuss the experience with the physician
    • 42. Student must not be made to convey information to the family directly
    • 43. The houseman should actively participate in such conveyance as part of his training albeit under supervision initially.
  • CONCLUSION