Laura Heesacker

1. Tools & Strategies to Support “Response-able” Action
03/12/2016
Having That Difficult Conversation
Start That Conversation Right!
Write your 1 minute elevator speech in the space below:
Note – Focus on patient safety and effectiveness of treatment. Avoid mentioning new laws, regulations, policies,
etc.
Managing Your Reactions
Below are some tips, tools, and strategies to help you remain “response-able” when
responding to challenging and desperate patient behaviors. Before you enter the patient
room:
1. Remind yourself why you are willing to have this difficult conversation.
2. Be clear on the outcome you hope to achieve and decide how flexible you are willing to
be – focus on what you are willing to do, rather than on what you will not do.
3. Brainstorm several treatment options that you feel good about presenting to your patient.
4. Identify permission phrases you can use to give your patient an increased sense of control
and input.
5. Mentally prepare for challenging behaviors and statements – rehearse your elevator
speech; predict how the patient might react and think about what you will say in
response.
6. Separate the person from their behavior and actions – remember that the challenging and
desperate things patients might say and do are born out of fear and anxiety, not malice.
7. Breathe. Self-talk. Remain objective and calm – draw strength from your values and core
beliefs.
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2. Tools & Strategies to Support “Response-able” Action
03/12/2016
8. Remind yourself to “actively listen” to your patient – validate their emotions.
9. Remember the significance of emotions in living with and treating CCNP – go above and
beyond to make your patient feel cared for. It is all about their health, safety, and long-
term happiness!
Predictable Patient Reactions to the Request to Change Their Treatment Regimen
Be prepared to compassionately and objectively respond to these common patient
“negotiations”:
“You do realize I won’t be able to work now don’t you? Is that what you want, for me to lose
my job?”
“You’re telling me to <<insert non-opioid treatment>> but I can’t even get out of bed without
my pills.”
“If you take away my pills I won’t be able to look after my children.”
“Basically, you’re saying you’re just going to let me suffer. Right?”
“You don’t know how much pain I’m in. You’re not me!”
“Do you want me to get my drugs from the street? That’s what I’ll have to do!”
“Well, I’m just going to go to the ER.”
“I guess I’ll just have to find another provider. Someone who believes me and cares!”
When confronted by these types of emotional and troubling reactions, it is natural to begin to
second guess yourself and question your decisions regarding your patient’s treatment.
However, do all you can to show them that you care about their health and remain “response-
able.” Instead of feeling responsible for your patient’s pain and suffering, you are remaining
objective so that you can make the decisions that you believe are in their safest and best
interest, even if they don’t like them.
Effective Responses
“It’s understandable that you feel <<insert emotion>> in regard to me not prescribing
narcotics…”
“This is a lot of information; it would be understandable if you were experiencing <<insert
emotion>>. As your provider, your safety and well-being are my primary concerns and we need
to make some adjustments to your treatment.”
“I certainly don’t want you to suffer. I care about your health a great deal. I’m confident that
you are capable of making the adjustments I’ve outlined.”
“At this point, maybe we can agree to disagree. Why don’t you take some time to consider
the three options we’ve discussed, and next week when you come in we will start with the
adjustments.”
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3. Tools & Strategies to Support “Response-able” Action
03/12/2016
“I certainly don’t want you to << insert patient threat (e.g. stay in bed, not go to work,
etc.)>> and due to the safety concerns we discussed, it’s important for us to move forward
with these changes.”
“Would you be willing to try the non-narcotic treatment options we discussed? I hear that
you’ve tried them in the past with no success, but I’m asking you to consider trying them
again.”
“I would like to offer you some new information we have about treating complex, chronic
pain. Would that be okay with you?”
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