• Save
Breaking Bad News IN INFERTILITY CASES Few tips
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Breaking Bad News IN INFERTILITY CASES Few tips

on

  • 282 views

 

Statistics

Views

Total Views
282
Views on SlideShare
282
Embed Views
0

Actions

Likes
1
Downloads
1
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

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”
  • 27. ABCDE is our first choice A- ADVANCE PREPARATION B- BUILD ENVIRONMENT / RELATIONSHIP C- COMMUNICATION WELL D- DEAL WITH REACTION E- ENCOURAGE & VALIDATE EMOTIONS
  • 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