This document discusses best practices for delivering bad news to patients. It notes that delivering bad news is stressful for physicians due to feelings of anxiety, responsibility, and fear of upsetting patients. It recommends gathering information from patients about their expectations beforehand. When delivering the news, physicians should provide clear, plain language information and check for understanding. They should acknowledge and support patients' emotional reactions with empathic responses. After delivering the news, physicians should assess patients' readiness to discuss treatment plans and answer any questions before summarizing and following up. The goal is to reduce stress for both patients and physicians while ensuring patients receive information and support.
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
A talk I gave in Al-Zaem Al-Azhary university on Thursday, 15/5/2014
Outline:
What do we mean by breaking bad news (BBN)?
Which news is bad? really bad? Like really, really bad !
Why should we care about BBN?
Ethical
Professional
Legal
BBN as part of the Communication Cycle/Pathway
Practical approaches to BBN:
SPIKES
ABCDE
BREAKS
The Do Not's in BBN
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
Professionalism is the basis of medicine’s social contract with society
Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health
Empathy is the capacity to recognize and experience feelings that are being experienced by another.
“It is the intrapersonal realization of another’s plight that illuminates the potential consequences of one’s own actions on the lives of others.” (Hollingsworth, 2003)
A talk I gave in Al-Zaem Al-Azhary university on Thursday, 15/5/2014
Outline:
What do we mean by breaking bad news (BBN)?
Which news is bad? really bad? Like really, really bad !
Why should we care about BBN?
Ethical
Professional
Legal
BBN as part of the Communication Cycle/Pathway
Practical approaches to BBN:
SPIKES
ABCDE
BREAKS
The Do Not's in BBN
Last semester's lecture on truth telling and breaking bad news to patients. It was presented by Dr Ghaiath Hussein for Farabi Medical College medical students.
Professionalism is the basis of medicine’s social contract with society
Professionalism demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health
Empathy is the capacity to recognize and experience feelings that are being experienced by another.
“It is the intrapersonal realization of another’s plight that illuminates the potential consequences of one’s own actions on the lives of others.” (Hollingsworth, 2003)
Medical errors are a growing concern in health care organizations.
No matter how well trained or hard working, healthcare providers make mistakes, just like other professionals.
Some data suggest that medical errors occurs up to 80 times per 100,000 consultations.
Medical errors are the third leading cause of death in the United States.
Communication: Empathy and How To Give Bad News -Journal Article and Discussionflasco_org
Providing a course that is relevant, practical and patient-centered that will positively impact the speed in which entry-level oncology specialists integrate into the oncology practice setting.
This presentation mainly explains about the type of patients that are encountered in day to day practice as well as how each of them should be handled to improve the communication between a doctor and the patient.
Archer USMLE step 3 Ethics lecture notes. These lecture notes are samples and are intended for use with Archer video lectures. For video lectures, please log in at http://www.ccsworkshop.com/Pay_Per_View.html
The process of curing a patient requires an approach which involves considerations beyond treating a disease. It requires several skills in a doctor along with technical expertise. Studies have shown that good communication skills in a doctor improve patient’s overall satisfaction.
To the consultation, the patient brings ideas, concerns, expectations, feelings and emotions related to his health problem. These areas are often grouped together and called the “Patent’s Agenda”.
Some of these emotional concerns may be explicit “Open Agenda”, but a large part may never be expressed openly if doctors do not proactively elicit them.
In 1981, Barsky, an American psychiatrist, gave a name to this assortment of hidden concerns; he called it the “Hidden Agenda”.
An important objective of a medical consultation is to understand as much as possible these hidden emotions.
Unless the doctor is able to fathom these, the patient may only be left with therapy that will treat his most obvious symptoms but not resolve the underlying problems.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
2. “Any information which adversely and
seriously affects an individual’s view of
his or her future”
Bad news always, depends on the
recipient’s expectations or understanding.
3. Patients Want the Truth
A Frequent but Stressful Task
Clinical Outcomes
Ethical and Legal Imperatives
4. The Bearer of bad news often experiences strong
emotions such as anxiety, a burden of responsibility
for the news, and fear.
This stress creates a reluctance to deliver bad news,
which is called the “MUM” effect. The MUM effect is
particularly strong when the recipient of the bad
news is Already distressed.
Lack of training, guidelines, experience of the
physician.
5. To make a plan
Increase physician confidence.
Encourage patients to participate in difficult
treatment decisions.
Less stress and burnout.
6. Gathering information from the patient.
This allows the physician to determine the patient’s
knowledge and expectations and readiness to hear the
bad news.
Provide clear information in accordance with the
patient’s needs and desires.
Support the patient by reducing the emotional
impact and isolation experienced by the recipient of
bad news.
Develop a strategy in the form of a treatment plan
with the input and cooperation of the patient.
7.
8. Mental rehearsal is a useful way for preparing for
stressful tasks.
Although bad news may be very sad for the
patients, the information may be important in
allowing them to plan for the future.
Arrange for some privacy
Involve significant others
Sit down, provide comfortable space.
Establish good rapport
Manage time constraints and avoid interruptions
9. Prepare before speaking. BEFORE U TELL ASK
Before discussing the medical findings, the clinician uses open-
ended questions to create a reasonably accurate picture of how
the patient perceives the medical problem.
Based on this information you can correct misinformation and
tailor the bad news to what the patient understands.
It can also accomplish the important task of determining if the
patient is engaging in any variation of illness denial.
10. Ask questions to invite the patient into conversation.
While a majority of patients express a desire for full information
about their diagnosis, prognosis, and details of their illness, some
patients do not.
When a clinician hears a patient express explicitly a desire for
information,it may lessen the anxiety associated with divulging
the bad news.
Shunning information is a valid psychological coping mechanism
which can be manifested as the illness becomes more severe
If patients do not want to know details, offer to answer any
questions they may have in the future or to talk to a relative or
friend.
11. Warning the patient that bad news is coming may lessen the
shock. Begin with “I’m sorry to tell you that…”.
First, start at the level of comprehension and vocabulary of the
patient. Use plain language.
Second, try to use nontechnical words such as “sample of tissue”
instead of “biopsy.”
Third, avoid excessive bluntness, mind body language.
Fourth,give information in small chunks and pause, check
periodically as to the patient’s understanding.
Fifth, when the prognosis is poor, avoid using phrases such as
“There is nothing more we can do for you.”
use teach back” to verify that the message was received.
12. Patients emotional reactions may vary from silence to disbelief,
crying, denial, or anger and express shock, isolation, and grief.
In this situation the physician can offer support and solidarity to
the patient by making an empathic response.
An empathic response consists of four steps-
First, observe for any emotion on the part of the patient.
Second, identify the emotion experienced by the patient. If a
patient appears sad but is silent, use open questions to query the
patient as to what they are thinking or feeling.
Third, identify the reason for the emotion. This is usually
connected to the bad news. However again, ask the patient.
Fourth, give the patient a brief period of time to express his or
her feelings let the patient know that you have connected the
emotion with the reason for the emotion by making a connecting
statement.
13. Doctor: I’m sorry to say that the x-ray shows that
the chemotherapy doesn’t seem to be working [pause].
Unfortunately, the tumor has grown somewhat.
Patient: I’ve been afraid of this! [Cries]
Doctor: [Moves his chair closer, offers the patient a
tissue, and pauses.] I know that this isn’t what you
wanted to hear. I wish the news were better.
In the above dialogue, the physician observed the
patient crying and realized that the patient was tearful
because of the bad news. He moved closer to the
patient. At this point he might have also touched the
patient’s arm or hand if they were both comfortable
and paused a moment to allow her to get her
composure. He let the patient know that he understood
why she was upset.
14. Until an emotion is cleared, it will be difficult to go on to discuss
other issues.
If the emotion does not diminish shortly, it is helpful to continue to
make empathic responses until the patient becomes calm.
Again, when emotions are not clearly expressed, such as when the
patient is silent, the physician should ask an exploratory question
before he makes an empathic response.
combining empathic, exploratory, and validating statements is
one of the most powerful ways of providing that support .
It reduces the patient’s isolation, expresses solidarity, and
validates the patient’s feelings or thoughts as normal.
15. Empathic statements Exploratory questions Validating responses
“I can see how
upsetting this is to
you.”
“Tell me more about
it.”
“I guess anyone might
have that same
reaction.
“I know this is not good
news for you.”
“Could you explain
what you mean?”
Many other patients
have had a similar
“experience.”
“This is very difficult
for me also.”
Could you tell me what
you’re
“worried about?”
“I can understand how
you felt that way.”
“I was also hoping for a
better result
Now, you said you were
concerned about
“your children. Tell me
more.”
You were perfectly
correct to think that
way
16. Assess patients readiness for planning
• Negotiate next steps
• Acknowledge and answer questions
Summarize plan
• Use “teach back” technique
• Follow up.
17. Before discussing a treatment plan, it is important to ask patients
if they are ready at that time for such a discussion.
Presenting treatment options to patients when they are available
is not only a legal, but it will establish the perception that the
physician regards their wishes as important.
Sharing responsibility for decision-making with the patient may
reduce the sense of failure on the part of the physician when
treatment is not successful.
Clinicians are uncomfortable when they discuss prognosis and
treatment options with the patient, if the information is
unfavorable.
18. These difficult discussions can be greatly facilitated by using
several strategies.
First, many patients already have some idea of the
seriousness of their illness and of the limitations of treatment
but are afraid to bring it up or ask about outcomes.
Second, understanding the important specific goals that many
patients have, such as symptom control, and making sure that
they receive the best possible treatment and continuity of care
will allow the physician to frame hope.
This can be very reassuring to patients.
19. “If we do it badly,
the patients or family members
may never forgive us, and
if we do it well,
they may never forget us”.