Secretes of Breaking Bad News Few tips by Dr. Sharda Jain (Lifecare Centre)

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Secretes of Breaking Bad News Few tips by Dr. Sharda Jain (Lifecare Centre)

  1. 1. Secretes of Breaking Bad News Few tips Director s: Dr. Sharda Jain
  2. 2. I Dedicate this PPT to my Colleagues & Patients Review This Lecture at slideshare.net
  3. 3. Professional life is like a game Some time you win At other time you lose You have to take it in your
  4. 4. EVER SINCE THE SUPREME COURT BROUGHT THE PATIENT – DOCTOR RELATIONSHIP UNDER THE AMBIT OF THE CONSUMER PROTECTION ACT IN 1995, THE NUMBER OF COMPLAINTS AGAINST DOCTORS HAS GONE UP in India
  5. 5. Do No Harm Deliver Best to T he Patients
  6. 6. “Today , you will see that MOST SUCCESSFUL DOCTORS are those who have Good communication skills. It pays to be patient to the patients
  7. 7. Human Emotions are Most Difficult to Predict , especially in a STRESSFUL environment like UNFAVORABLE DISEASE or DEATH in a hospital so… Doctor need to be extra careful while talking to patients & relatives
  8. 8. Concerns & Realities Walk into the major LABOUR WARD of any government hospital, and you’re likely to find patients / relatives VERY CRITICAL with treatment given.
  9. 9. In the CANCER WARD, families of patients complain • Doctors don’t offer much advice • Alternatives are not detailed • How to manage the debilitating pain associated with the disease. Concerns & Realities
  10. 10. “At times , physicians do end up losing patients for being “Rude & Uncaring”
  11. 11. 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 ?
  12. 12. What is bad News? It is any information which is Likely to ALTER DRASTICALLY A PATIENTS VIEW OF THE FUTURE all together …
  13. 13. VARIOUS IDEAS on BAD NEWS? • Feeling of NO HOPE, • A threat to a person’s Mental or physical well being • A risk of Upsetting An Established Lifestyle or • Where a message is given which conveys to an individual fewer choices in her life (ptacek & Eberhardt TL, 1996) • “any news that drastically and negative alters the patients view of her or his future” is bad news. (Buckman, 1984)
  14. 14. What Constitute BAD NEWS in O/G ? STIGMATIZATION HIV----------------------------------------------------------------------------------------------------------------------------------- INFERTILITY -------------------------------------------------------------- • Azoospermia • B/L patent tubes • IVF failure UNFAVORABLE DIAGNOSIS------------------------------------------- ------------------------------------------------------------------------------- Irreversible , un-treatable or non- stoppable disease / side effects/ complications CANCER------------------------------------------- ---------------------------------------------------------------------------------------- YOUNG AGE Recurrence Spread of disease Late stage ---------------------------------------------------------------------------------------------- • STILL BIRTH • NND in 1st 24 hrs • Rec. Mole • Rec. Pregnancy Los PREGNANCY DEATH DEATH / DOT
  15. 15. Various Situations Faced by Gynaecologists Bad Diagnosis C A N C E R I N F E R T I L I T Y Azoospremia Still Birth B/L Block Tubes DOT NND IVF failure Death in O/G Rec. Miscarriage Endometriosis
  16. 16. Any of these Condition has potential to surprise the Great gynaecologists by sudden occurrence. This may occur in spite of taking all pro-active precautionary measures. Although awareness and readiness to face and tackle all possible mishaps would minimize complications, to a large extent. However it cannot always be eliminated all together. Bad News
  17. 17. INFORMED CONSENT is vital for gynaecologists to fully make them understand Counseling / Video Recording
  18. 18. DEATH on Operation Table (DOT) in O/G is extreme rarity
  19. 19. DOT 80/20
  20. 20. It is like death in police custody where there is no help for patient & nobody knows the facts except doctors & their team. DOT/ Still Birth Arrest
  21. 21. 1 Real Life Incidents PGI Chandigarh 52 years, Doctor's aunt came with PM bleeding. Patients had no co-morbidity All tests were normal from pre OT area patient was shifted on trolley and before she could be transferred on OT table - she was NO MORE
  22. 22. DEATH Obstetrics / Gynaecology Is no joke !!!
  23. 23. A Gynaecologist is caught at least once in lifetime in this tragedy !!
  24. 24. Real Life Incidents Primi. had elective LSCL for breach After smooth surgery had pulmonary odema & died
  25. 25. Biggest Bombshell Still Birth at term or NND in 24hrs. Litigation + + +
  26. 26. Recurrent Miscarriage Recurrent IVF Failures CANCER Young age Last stage Recurrence REQUIRES CAREFUL HANDLING
  27. 27. “Ending Treatment” Cancer Infertility Rec. Miscarriage When to advice patients that “enough is enough” Endometriosis
  28. 28. Cause of Litigations is Lack of Empathy Lack of Communications • Over work • Over tired • Explained before Are Silly Doctor’s Excuses
  29. 29. Support Systems • Denial • Despair • Anger • Bargaining • Depression • Acceptance Emotional Responses to a bad News
  30. 30. Breaking Bad News is an ART Doctors - today are realizing that they have to deliver Bad News Diagnosis with care
  31. 31. Breaking some BAD NEWS for us! Is the MOST DIFFICULT TASK !! This ART – We All Have to Learn it
  32. 32. Soft skills of BBN are NOT Taught in Medical Colleges YOU ARE LUCKY TO HAVE GOOD BOSS / MENTOR !!
  33. 33. Doctors need to polish soft skills to Deliver “Tough” Bad News
  34. 34. BLAT • BUILD TRUST • LISTEN , • APOLOGIZE, • THANKS “in our practice it helps us in dealing with difficult situations and breaking bad news Is our 1st choice
  35. 35. ABCDE our second choice A- ADVANCE PREPARATION B- BUILD ENVIRONMENT / RELATIONSHIP C- COMMUNICATION WELL D- DEAL WITH REACTION E- ENCOURAGE & VALIDATE EMOTIONS
  36. 36. Other Practical Approaches to BBN SPIKES Setting and listening skill Patient perception Invitation to give Information Knowledge Explore Emotion & Empathize Strategy and summarize BREAKS B- BACGROUND R- RAPPORT E- EXPLORE A- ANNOUNCE K – KINDLING S- SUMMARIZE
  37. 37. Practical Tips
  38. 38. Keep a Bold Face !! • Preserve maintain reasonable EMOTIONAL BALANCE • Preserve a satisfactory SELF – IMAGE and sense of Competence.
  39. 39. What are we worried about…? DOT/ Death/ Still Birth • Breaking the news • Damage to reputation • Facing questions of relatives • Fear of mob violence • Handling police enquiry • Medico-legal issues – arrest, courts, case, judgment… • Compensation amount • Loss of confidence • Stress in future cases
  40. 40. How to Handle The Situation…  Gather  Ask for help.  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”
  41. 41. Communication is two way Process
  42. 42. Communication Skills  Good communication by Sr. & Reputed Consultant can prevent litigation  RELATIVES WANT to know TRUTH  Sympathetic approach
  43. 43. Anticipate Reaction of Relatives & handle it well  Shock  Pain  Anger  Guilt  Depression
  44. 44. • Avoid aggression or putting blame on relatives • Staff should not contradict statements made by consultants to avoid misinterpretation by relatives. • Do not refuse to give records or refuse postmortem, rather suggest it from your side. Communication Skills
  45. 45. Being Sensitive to the Relatives  While you proceed read the non-verbal clues; face/body language, silence, tears  Allow for “shut down” (when relatives turn off & stop listening) give time & space: allow possible denial  Give opportunity to ask questions  Arrangements for taking away the dead body.  Registering the death
  46. 46. Strategies for coping crisis in infertility/ IVF /obstetrics Meaningful 1st counseling of couple – biggest tip Be mentally prepared to accept failure Accept & Redefine goals After crisis – problem focused BBN 1. EMOTIONAL DISCHARGE 2. Encourage CALM ACCEPTANCE 3. Be a PROBLEM SOLVER 4. Explain ALTERNATIVES
  47. 47. BBN in pregnancy / 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”
  48. 48. 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
  49. 49. 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 examples
  50. 50. Last, But Not The Least…..  Stop thinking about it constantly  Take a small break  Keep your morale & self confidence intact  Learn the lesson it teaches Even with simplest case or operation it can not be taken for granted that patient will come out Better of or even alive
  51. 51. Soft Skill Workshops Group Sharing Role Plays
  52. 52. Creative workshop for Doctors & Medical Students to make them • Expressive • Empathetic • Concerned • But bold & self confident
  53. 53. Left you with many Qunanswered
  54. 54. 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

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