This document discusses the importance of breaking bad news skillfully for gynecologists. It notes that communication skills are essential to building trust with patients and avoiding litigation. Several frameworks are presented for delivering bad news, including showing empathy, building rapport, addressing emotional reactions, and encouraging questions. Specific challenges of breaking news of infertility, cancer diagnoses, or deaths are explored. The document stresses practicing active listening, acknowledging emotions, being honest yet compassionate, and following up with support and counseling. Overall it argues that breaking bad news is an important yet difficult task that requires training to properly support patients.
BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.
There is an evident deficiency on how best to break bad news in medicine. This is an essential communication skill that our patients expect of us. It is an essential requisite of Good Medical Practice. This presentation is part of a course held at Al Hammadi Hospital, Suwaidi, Riyadh, KSA on Breaking Bad News. 2017
BBN - Breaking Bad News is difficult task for Junior doctors in India as it was not in the Curriculum unlike Western countries. So this slide will give you the Facts / Methods with Description of one method & Key points.
There is an evident deficiency on how best to break bad news in medicine. This is an essential communication skill that our patients expect of us. It is an essential requisite of Good Medical Practice. This presentation is part of a course held at Al Hammadi Hospital, Suwaidi, Riyadh, KSA on Breaking Bad News. 2017
It is part of the job to regularly break bad news, yet training for doctors and nurses on how to disclose distressing news to patients or relatives is markedly unappreciated, until now.
Most professionals develop their own appropriate techniques for breaking such news
. Studies in the child disability field in USA and other western countries reveal that about 50% of parents are dissatisfied with the way news of their son's or daughter's disability was given to them
How to break bad news
1- Getting started:
a. Get the physical setting right
b. Ensure family support at the time of breaking the news
c. Fire a warning shot
2- Find out how much the patient already knows
3- Find out how much the patient wants to know
4- Decide on your objectives
5- Share the information
a. Give the information in small chunks
b. Use English, not “medispeak”
c. Reinforce and clarify the information frequently
d. Listen for the patient’s feelings
e. Blend your agenda with the patient’s agenda
f. Offer hope
Bad news may be:
Sudden death & unexpected complications and changes in the course of illness.
Hopeless cases & No resuscitation decision (minimal medical interference )
Genetic disorders & congenital anomalies
Brain damage & long term Prognosis
HOW TO DELIVER A BITTER PILL
GENERAL RULES:
Introduce yourself if you have not met the parents
Private room , a curtain drawn around patient if not possible to move to private room
Sit down on the same level as the parents & the patient.
Free from interruptions, checking that pagers & mobile phones are switched off. Doctors are encouraged to allow patients or relatives the feeling that they have their unlimited consultation time & attention.
Good eye contact
Sensitivity and honesty are paramount
Correct names are used.
Note questions or topics avoided.
Respect the patient's right to "denial". They will often "selectively perceive" information they can cope with.
Appreciate that patients can, and do, cope positively with truth about illness.
Tell staff what has been said. They might be involved in future discussions.
Realize that most patients become aware of their situation gradually, rather than during one meeting. Arrange for a second interview between the parents within 24-48 hours
THE MANNER OF TELLING
Honestly -- with uncertainties acknowledged.
Straightforward, without embarrassment.
Explanations should be clear and not overly technical
Invite parents to ask questions
Offer to introduce parents to another parent with a child with similar condition ???????
What If... The parents start crying ??????????You should pause and say soothing statements like :
I am sorry to have to give you this news.
It is not easy for me. I know that this is not what you were expecting to hear this.
I understand and appreciate deeply your feelings……etc
Don’t say “Cheer up. Things could be worse”
What If The patient becomes angry? “I am sorry
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
The first of a 2-day class on Geriatric issues for nursing staff at all 4 Piedmont hospitals funded by a HRSA Comprehensive Geriatric Education Grant 2009-2012.
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
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The Newer Concepts for Reduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
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How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
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SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
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. Cause of Litigations
Is
* Lack of Empathy
* Lack of Good
Communication skills
• Over work
• Over tired
• Explained before
Are Silly
Doctor’s
Excuses
11. MOST SUCCESSFUL DOCTORS
are those who have
Breaking
Bad
News
Good
communication skills.
Mandatory to learn SOFT SKILLS how to BBN to patients & family
12. Every Day’s
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.
13. Concerns & Realities
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.
14. “At times ,
causalities
happen & doctors
end up having
”RUDE & UNCARING“
Behavior of Public
Kerela Gynaecologist beaten – up
August 2014
15. What do you Think
is BAD NEWS ?
• What is bad news?
• What went wrong?
• Could it be avoided.
• How will you react –
if you were the patient
or relative ?
16. What is bad News?
It is any information which is
Likely to
• ALTER DRASTICALLY
A PATIENTS VIEW
OF THE FUTURE all together …
*
• ALTER PATIENT’S LIFE
ALL TOGETHER
17. 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
• Left with fewer choices in her life
(ptacek & Eberhardt TL, 1996)
• News that drastically and negatively
alters her or his future”
(Buckman, 1984)
18. 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
PREGNANCY
----------------------------------------------------------------------------------------------
• STILL BIRTH
• NND in 1st 24 hrs
• Rec. Mole
• Rec. Pregnancy Los
• Cereble palsy
• Thal. Major
DEATH / DOT
19. Various Situations Faced by
We Gynaecologists
Bad
Diagnosis
CANCER
INFERTILITY
Azoospremia
Still
Birth
B/L Block Tubes
DOT NND IVF failure
Death
in O/G
Rec.
Endometriosis
Miscarriage Cerebral palsy
Thala. Major
20. Bad News
Can not be eliminated all together !!
Professional life is like a GAME
Some time you win
At other time you lose
You have to take it in your stride …
24. 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
29. DOT / Still Birth
It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
Litigation Arrest
31. Counseling for “Ending
Treatment” is “Big Dilemma”
When to advice patients that
“enough is enough”
Cancer Infertility Rec.
Miscarriage
Endometriosis
33. Why Difficult ??
• Both Party are UPSET
• NOT PLEASANT task by doctors
• TAXING for both (BBN / receiving BN )
• LOUSY JOB has long lasting impact &
repercussion.
This ART – We All Have to Learn it
34. Doctors - today are
realizing that they have to
deliver Bad News /
Diagnosis with care
Breaking Bad News
is an ART
35. LET US RECAP
Emotional Responses to a bad News
• Denial
• Despair
• Anger
• Bargaining
• Depression
• Acceptance
S upport Sys tems from doctor is must
36. Doctors Need to Polish Soft
Skills to Deliver
“Tough”
Bad News
Strategies
Challenges
37. ABCDE our 1st choice
A- ADVANCE PREPARATION
B- BUILD ENVIRONMENT / RELATIONSHIP
C- COMMUNICATION WELL
D- DEAL WITH REACTION
E- ENCOURAGE & VALIDATE EMOTIONS
38. BLAT
• BUILD TRUST
• LISTEN ,
• APOLOGIZE,
• THANKS
Is our 2nd choice
“in our practice it helps us in dealing with
difficult situations and breaking bad news
39. Other Practical Approaches to BBN
SPIKES
BREAKS
Setting and listening skill
B- BACGROUND
Patient perception
R- RAPPORT
Invitation to give
E- EXPLORE
Information
A- ANNOUNCE
Knowledge
K – KINDLING
Explore Emotion &
S- SUMMARIZE
Empathize
Strategy and summarize
41. Keep a Bold Face !!
• Preserve maintain
reasonable
EMOTIONAL BALANCE
• Preserve a satisfactory
SELF – IMAGE and
sense of Competence.
Never worry, “Be concerned”
42. 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
43. How to Handle The Situation…
Death / DOT / Still Birth
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”
45. Communication Skills
Good & honest communication by
Sr. & Reputed Consultant can prevent
litigation
RELATIVES WANT to know TRUTH
Sympathetic approach
Be honest
46. Anticipate Reaction of Patients /
Relatives & Handle it Well
Shock
Pain
ANGER
Guilt
DEPRESSION
47. Communication Skills
• 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.
48. Being Sensitive to Verbal & Nonverbal
Language of the patients & Relatives
While you proceed read the non-verbal clues;
face/body language, silence, tears
Give time & space:
EMOTIONAL DISCHARGE
Give opportunity to ask questions
49. Strategies for coping crisis in
infertility/ IVF /obstetrics
Meaningful 1st Counseling of couple
biggest tip
Be mentally prepared to ACCEPT FAILURE
After crisis – problem focused BBN
1. EMOTIONAL DISCHARGE
2. Encourage CALM ACCEPTANCE
3. Be a PROBLEM SOLVER
4. Explain ALTERNATIVES – to move ahead
50. 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”
51. Relaxation technique &
psycho therapeutic counseling
Helplessness
• 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
doctor you are Great !! Now - I can handle the problems
related to my infertility / Pregnancy Loss
52. BBN for “Ending Treatment”
is Another big task
* A patient – centered emotionally
focused approach is the key
* Help 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 Real Life examples
53. INFORMED CONSENT
Is to be taken seriously
o Is vital for gynaecologists to fully understand the
importance of counseling & take
STD / High Risk Consents
Video Recording
(if smelling problems !!)
55. Last, But Not The Least…..
Every new day brings CHALLENGES AND OBSTACLES
Stop thinking about it constantly at HOME
Keep your morale & self confidence intact
Learn the lesson it teaches
Take a small break
56. Arrange
Soft Skill Workshops
for gynaecologists
• Leaders to speak
• Experience Sharing
• Role Plays
57. Creative workshop for Doctors &
Medical Students
to make them
• Expressive
• Empathetic
• Concerned
• But bold & self confident
