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Breaking Bad News IN INFERTILITY CASES Few tips
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Breaking Bad News IN INFERTILITY CASES Few tips






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Breaking Bad News IN INFERTILITY CASES Few tips Presentation Transcript

  • 1. Breaking Bad News IN INFERTILITY CASES Few tips Director Dr. Sharda Jain
  • 2. I Dedicate this PPT to my Colleagues & Patients Review This Lecture at slideshare.net
  • 3. Do No Harm Deliver Best to T he Patients
  • 4. “Today , you will see that MOST SUCCESSFUL DOCTORS are those who have Good communication skills. It pays to be communicative to the patients
  • 5. I view Professional life is like a Game Some time you Win At other time you Lose You have to be part of sorrow of your clients Biggest challenge to me is BBN in infertility Cases & their pregnancy loss …
  • 6. Human Emotions are Most Difficult to Predict , Especially in a STRESSFUL environment like Infertility & IVF clinics & you have to break the Bad Bews so… Doctor need to be extra extra careful while talking to patients & relatives
  • 7. What do you Think is BAD NEWS ? • What is bad news? • How bad? • What went wrong? • How could it have been done better ? • What if you were the patient or relative - how will you take it ?
  • 8. What is bad News? It is any information which is Likely to • ALTER DRASTICALLY A PATIENTS VIEW OF THE FUTURE all together … • Feeling of NO HOPE • Left with fewer choices in life
  • 9. Various Situations Faced by Gynaecologists I N F E R T I L I T Y Azoospremia B/L Block Tubes POF Mullerian Agenesis Endometriosis I V F Failure Pregnancy Loss
  • 10. • With these diagnosis 70% patients reported the they were unsatisfied with the manner in which the previous doctor infirm them about the diagnosis • 90% reported experiencing significant emotional of diagnosis Emotional distress = Degree of dissatisfaction At BBN Wanted more emotional support ; wanted more time Experience
  • 11. On investigations of Infertility “Wife” is found to be HIV POSITIVE Real Life Incidents Stigmitisation
  • 12. On investigation of infertility young girl of 24 yrs, married for 2 yrs found to have B/L Blocked Tube At Laparoscopy FROZEN PELVIC & milliary TB Real Life Incidents
  • 13. Young boy 26yrs, IT professional, found to have Azoospermia Real Life Incidents
  • 14. Married for 10 yrs age 36 yrs 2 IVF First chemical pregnancy Second IVF failure Real Life Incidents
  • 15. Breaking Bad News Doctors - today are realizing that they have to deliver Bad News Diagnosis with care
  • 16. Breaking some BAD NEWS for us! Is the MOST DIFFICULT TASK !! This ART – We All Have to Learn it
  • 17. Soft skills of BBN are NOT Taught in Medical Colleges YOU ARE LUCKY TO HAVE GOOD BOSS / MENTOR !!
  • 18. Doctors need to polish soft skills to Deliver “Tough” Bad News
  • 19. Soft Skill Workshops Group Sharing Role Plays
  • 20. Creative workshop for Doctors & Medical Students to make them • Expressive • Empathetic • Concerned • But bold & Self confident
  • 21. Practical Tips
  • 22. Mandatory Pre - Counseling for IVF patients • Certain countries such as Canada and Australia mandate precounseling for IVF patients. • Good Centres in UK & USA do the same 60% couple found it useful 80% admitted they want to have counseling when to end treatment too.
  • 23. Strategies for coping crisis in infertility/ IVF /obstetrics “Meaningful 1st counseling of couple – biggest tip” • Mentally prepare the couple to accept failure • Acceptance of facts & Resetting of goals after each medical intervention is necessary .
  • 24. INFORMED CONSENT BEFORE IUI / IVF CYCLE is vital for gynaecologists to fully make them understand Counseling / Video Recording
  • 25. What are we Worried about…? • Breaking the news • Damage to reputation • Facing questions of relatives • Loss of confidence • Stress in future cases • Litigation is normally not there
  • 26. How to Handle The Situation…  Gather courage  Be Bold  Relax  Review sequence of events  Do not adopt a “Blame Culture”  Proper documentation  No discrepancies in records  No comments by junior staff Never worry, “Be concerned”
  • 28. BLAT • BUILD TRUST • LISTEN , • APOLOGIZE, • THANKS “in our practice it helps us in dealing with difficult situations and breaking bad news Is our second choice
  • 29. Keep a Bold Face !! • Preserve maintain reasonable EMOTIONAL BALANCE • Preserve a satisfactory SELF – IMAGE and sense of Competence.
  • 30. Communication is two way Process
  • 31. Communication Skill  Good communication by Sr. & Reputed team leader is the key .  RELATIVES WANT to know TRUTH  Very - Sympathetic approach Never worry, “Be concerned”
  • 32. Anticipate Reaction of the Patient & Relatives & Handle it well…  Shock  Pain  Anger  Guilt  Depression
  • 33. BBN in Infertility is all together different game !! “Their first reaction is disbelief, then blame and anger .. as a doctor, don’t say anything , just hold their hand and let them vent their anger . They generally come back and talk to you after a while”
  • 34. Strategies for coping crisis in infertility/ IVF / Pregnancy Loss After crisis – problem focused BBN 1. EMOTIONAL DISCHARGE 2. Encourage CALM ACCEPTANCE 3. Be a PROBLEM SOLVER 4. Explain ALTERNATIVES
  • 35. Relaxation technique & psycho therapeutic counseling Helplessness doctor you are Great !! Now - I can handle the problems related to my infertility / Pregnancy Loss • Help her to speak - up • Improve decision making skill •Advice for treatment holidays • Problem solving skill • Benefits of physical well – being • Nutrition. • Spiritual counseling Acceptance
  • 36. • Avoid aggression or putting blame on patient & relatives • Staff should not contradict statements • Do not refuse to give records Specially of the IVF lab rather suggest it from your side for second opinion . Communication Skills
  • 37. Pregnancy Loss following infertility treatment is most grave traumatic event • Couple feels intense emotions • Virtual isolation • Lack of social support • The narcissistic and object loss makes grieving most difficult.
  • 38. • The goal of intervention is A. Felicitate grieving and B. To restore narcissistic equilibrium. • SUPPORT FROM US (A) help her in creating a MEMORY BOX or album (sonogram picture , lab reports of UPT, ET photograph, cards of congratulation of IVF centre) (B) Memorial Activity - planting a tree / donation or any other charitable activity.s Pregnancy Loss following infertility treatment
  • 39. BBN for “Ending Treatment” infertility Whether patient or doctor initiated is Also considered a BAD NEWS & It should be handled by TEAM LEADER
  • 40. • Denial • Despair • Anger • Bargaining • Depression • Acceptance Emotional Responses to a bad News BBN for “Ending Treatment”
  • 41. BBN for “Ending Treatment” * A patient – centered emotionally focused approach is the key * Let the patient set the agenda •Help them to find MEANING IN LIFE , Assist them in REDEFINING GOALS • To promote long term adjustment in life by giving live examples
  • 42. Last, But Not The Least….. • You cant give babies to every body • Leave “ Office Problems in office” • Learn the lessons of life – it teaches • Every case gives you maturity • Keep your morale & self confidence intact
  • 43. Left you with many Qunanswered
  • 44. ADDRESS 11 Gagan Vihar , Near Karkari Morh Flyover Delhi -51 CONTACT US 9650511339 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com