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
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.
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
