This document provides guidance on effectively breaking bad news to patients. It discusses the importance of this communication skill for healthcare professionals. The document outlines best practices for setting, perception checking, invitation, knowledge sharing, exploring the patient's response, and summarizing. Key aspects include ensuring privacy, empathy, clarity, and allowing time for the patient's questions and reactions. The SPIKES protocol is presented as a framework for structuring the discussion. Examples of both best practices and things to avoid are also highlighted.
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
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
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
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
Better health, better lives conference tuesday 20 june 2017 - workshopsNHS England
1. Using reasonable adjustments to improve health care – Anna Marriott and Siraaj Nadat
2. Stop Overmedication of people with learning disabilities (STOMP) – David Branford, Carl Shaw, Jill
Parker and David Gill
3. The Right Care Diabetes Pathway – Jane Kachika
4. Lab in a bag – Stephamie Laconianni
5. Don’t miss out – having a health check and using the GP – Rachel Ashcroft & Harry Roche
6. SeeAbility – Scott Watkin & Stephen Kill
7. Summary care records
Lecture on the definition and the principles of Breaking Bad News in clinical practice, prepared and presented by Prof. Faisal Ghani to Alfarabi Medical College Students
Communicating hope and truth: A presentation for health care professionalsbkling
Dr. Don S. Dizon, gynecologic oncologist at Massachusetts General Hospital Cancer Center, discusses the lessons he's learned while trying to communicate in an honest and hopeful way with patients facing a difficult diagnosis. This was presented as a webinar hosted by SHARE. If you'd like to view the complete webinar, go to www.sharecancersupport.org/dizon
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr. Tan Hui Siu, Paediatrician subspecialized in Bioethics from Ampang Hospital, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/j7t5n5-dnr-and-ethics-in-covid-19-era
•Don’t make firm predictions
•Do what predictions you do for yourself
•Don’t communicate unless asked
•Don’t be specific
•Don’t be extreme
•Be compassionate and optimistic
Bringing the patient voice into GSK for educational, awareness and patient ce...Nowgen
"Bringing the patient voice into GlaxoSmithKline for educational, awareness and patient centred decisions within medicine development", presented by Kay Warner, Global Manager, Focus on the Patient, GlaxoSmithKline, at the EUPATI-UK Network Conference on 6 March 2014 in Leeds, UK
ADDRESSING PHYSICIAN BURNOUT: IS IT THE ENVIRONMENT OR LACK OF RESILIENCY?Carescribr
Burnout has long been recognized as an occupational hazard for various people‐oriented professions, such as human services, education, and health care. These jobs require an ongoing and intense level of personal, emotional contact. If you speak to any physician they will likely confirm that although such relationships can be rewarding and engaging, they can also be quite stressful. One cultural aspect of these occupations is that they strive to be selfless and put others' needs first; they tend to work long hours and do whatever it takes to help others; to go the extra mile and to give one's all. This can put significant burden on physicians as work settings also tend to be high in demands and low in resources.
Better health, better lives conference tuesday 20 june 2017 - workshopsNHS England
1. Using reasonable adjustments to improve health care – Anna Marriott and Siraaj Nadat
2. Stop Overmedication of people with learning disabilities (STOMP) – David Branford, Carl Shaw, Jill
Parker and David Gill
3. The Right Care Diabetes Pathway – Jane Kachika
4. Lab in a bag – Stephamie Laconianni
5. Don’t miss out – having a health check and using the GP – Rachel Ashcroft & Harry Roche
6. SeeAbility – Scott Watkin & Stephen Kill
7. Summary care records
Lecture on the definition and the principles of Breaking Bad News in clinical practice, prepared and presented by Prof. Faisal Ghani to Alfarabi Medical College Students
Communicating hope and truth: A presentation for health care professionalsbkling
Dr. Don S. Dizon, gynecologic oncologist at Massachusetts General Hospital Cancer Center, discusses the lessons he's learned while trying to communicate in an honest and hopeful way with patients facing a difficult diagnosis. This was presented as a webinar hosted by SHARE. If you'd like to view the complete webinar, go to www.sharecancersupport.org/dizon
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr. Tan Hui Siu, Paediatrician subspecialized in Bioethics from Ampang Hospital, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/j7t5n5-dnr-and-ethics-in-covid-19-era
•Don’t make firm predictions
•Do what predictions you do for yourself
•Don’t communicate unless asked
•Don’t be specific
•Don’t be extreme
•Be compassionate and optimistic
Bringing the patient voice into GSK for educational, awareness and patient ce...Nowgen
"Bringing the patient voice into GlaxoSmithKline for educational, awareness and patient centred decisions within medicine development", presented by Kay Warner, Global Manager, Focus on the Patient, GlaxoSmithKline, at the EUPATI-UK Network Conference on 6 March 2014 in Leeds, UK
ADDRESSING PHYSICIAN BURNOUT: IS IT THE ENVIRONMENT OR LACK OF RESILIENCY?Carescribr
Burnout has long been recognized as an occupational hazard for various people‐oriented professions, such as human services, education, and health care. These jobs require an ongoing and intense level of personal, emotional contact. If you speak to any physician they will likely confirm that although such relationships can be rewarding and engaging, they can also be quite stressful. One cultural aspect of these occupations is that they strive to be selfless and put others' needs first; they tend to work long hours and do whatever it takes to help others; to go the extra mile and to give one's all. This can put significant burden on physicians as work settings also tend to be high in demands and low in resources.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
badnews.pptx
1. BREAKING BAD NEWS
A N E S S E N T I A L C O M M U N I C A T I O N S S K I L L
D R M O H A M A D A L - G A I L A N I
CO N SULTA N T SURGEO N
B R E A K I N G B A D N E W S C O U R S E
2 0 1 7
2. BAD NEWS
•Any news that drastically and
negatively alters the patient’s view
of his or her future
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
2
GAILANI 2017
3. EXAMPLES OF BAD NEWS
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
3
GAILANI 2017
•Cancer diagnosis
•Intra uterine foetal death
•Life long illness e.g. Diabetes, epilepsy
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5. PATIENTS HAVE A RIGHT TO:
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
5
GAILANI 2017
• Accurate and true information
• Receive or not receive bad news!
• Decide how much information they want or do not
want
• Decide who should be present during the
consultation, e.g. Family members
• Decide who should be informed about their diagnosis
and what information that person(s) should receive
6. RESPONSES TO BAD NEWS
• Denial
• Shock
• Anger
• Guilt
• Blame
• Agitation
• Helplessness
• Sense of unreality
• Misinterpreting
information
• Regret/anxiety
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
6
GAILANI 2017
7. DO…
• Ensure privacy and
confidentiality
• Respect
• Honest
• Simple language
• Listen
• Sensitive to the non-
verbal language
• Allow for silence, tears
and other patient
reactions
• Document and liaise
with the
multidisciplinary team
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
7
GAILANI 2017
8. DO NOT…
•Overload with
information
•Distort the truth
•Give false
reassurance
•Feel obliged to keep
talking all the time
•Withhold information
•Assume that you
know what is
concerning the
patient
•Criticize
•Make judgements
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
8
GAILANI 2017
9. AVOID
1. Meeting in public
2. Being alone
3. Hurrying!
4. Not being prepared!
5. Interrupted by your mobile phone!
6. Patronizing e.g. It is all your fault you smoked!
7. Give prognosis e.g. You have 6 months to live!
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
9
GAILANI 2017
11. 1. S: SETTING
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
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GAILANI 2017
Arrange for some privacy
Sit down
Make connection and establish rapport with
the patient
Manage time constraints and interruptions
12. 2. P: PERCEPTION
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
12
GAILANI 2017
Determine what the patient knows?
Listen to the patient!
Accept denial but do not confront at this
stage.
13. 3. I: INVITATION
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
13
GAILANI 2017
Ask patient if they wish to know?
Accept patient’s right not to know!
Offer to answer questions later if they wish
14. 4. K: KNOWLEDGE
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
14
GAILANI 2017
Use language appropriate to patient
Give information in small chunks
Give diagnosis e.g. Cancer
Give any positive aspects e.g. Cancer has not
spread
Check whether the patient understood what
you said!
15. 5. E: EXPLORE
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
15
GAILANI 2017
Prepare to give an empathetic response
Give the patient time to express their
feelings then respond
16. 6. S: STRATEGY (SUMMARY)
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
16
GAILANI 2017
Ask whether they want to clarify
something else?
Offer agenda for the next meeting e.g. I
will speak to you again when we have the
opinion of cancer specialist.
Close the interview
17. V I D E O
H O W N O T T O
B R E A K B A D N E W S
B R E A K I N G B A D N E W S C O U R S E 3 R D F E B R U A R Y
2 0 1 7 D R . M O H A M A D A L - G A I L A N I
18. HOW NOT TO
BREAK BAD NEWS
Scenario: Relative informed (in public) by a junior doctor of the
passing away of his father admitted to ER with a heart attack!
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
18
GAILANI 2017
19. VIDEO SCENARIO
•What went Wrong in this scenario?
1.Conducted in Public
2.Not given by the appropriate person
3.No Privacy
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
19
GAILANI 2017
20. S C E N A R I O
NEW
BREAST CANCER
DIAGNOSIS
( T h e c a s e o f M r s . A m a l )
DR. MOHAMAD AL-
BREAKING BAD NEWS COURSE
GAILANI
2017
21. SCENARIO: (The case of Mrs. Amal)
•10 minutes (Scenario): The Consultation
between Mrs. Amal and her surgeon Dr.
•Lee.
10 minutes: Observer remarks.
•10 minutes: Course Participants’ remarks
•General Discussion & Questions.
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
21
22. SCENARIO: (The case of Mrs. Amal)
• Mrs. Amal is a 38-year-old housewife who presented
with a 3-week history of feeling a lump in her right
breast.
• She has last week seen her surgeon Dr. Lee who after
examining her ordered investigations.
• The investigations included a mammogram,
ultrasound and a needle core biopsy from the lump
her right breast.
• She has come today for the Results of her
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
22
23. SCENARIO:
1. S: “Good afternoon Mrs. Amal”
2. P: “What do you know so far Mrs. Amal”?
3. I: “Would you like me to discuss your results”?
4. K: “I’m afraid Ihave some bad news for you”, K “The test
results regrettably confirmed my fears…of breast cancer”
5. E: Checks the patient has understood the bad news E Let
patient ask questions and to discuss their concerns E Gives
room to the patient’s feelings and silence.
6. S: “Can Isummarize what we have discussed”, S “Iwill
arrange for us to meet again next week”, S “Goodbye Mrs.
Amal, see you next Monday with your husband”
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
23
24. OBSERVER COMMENTS:
Interruptions.
CASE OF MRS. AMAL
• What went well? Privacy, Eye Contact, No
• Was it according to “SPIKES”? Yes
• Did Dr. Lee show Empathy, Knowledge,
Summate? Yes
• What could have been done better? Presence of
a Chaperon (Nurse), More Listening, Time for
Silence! BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
24
25. BREAKING BAD NEWS
SUMMARY
•A Difficult But Fundamentally Important Task
for All Health Care Professionals.
•Focused Training in Communication Skills &
Techniques Improves Performance.
•Enhances Patients’ Satisfaction & Physicians’
Comfort.
•An Essential Skill of Good Medical Practice.
BREAKING BAD NEWS COURSE DR. MOHAMAD AL-
GAILANI 2017
25
26. D R . M O H A M A D A L - G A I L A N I F R C S
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