It’s great when you can build a good rapport with patients and everything runs smoothly, but unfortunately, there are patients who can make your work more challenging than it already is.
Dealing with angry patients and family memberspadma puppala
Angry patients can evoke fight or flight responses in medical professionals. Inability to diffuse situation in a professional manner can lead to disastrous consequences. Here are few tips to effectively diffuse the situation
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.
Do you want bad patient relations? Do you want to lose patients? Do you want to fail your patient satisfaction surveys? Do you want a non professional image? Do you want to reduce the number of new patient referrals? Do you want to demonstrate poor quality care? Do you want to jeopardize participation in healthcare plans?
We can Help you :)
It’s great when you can build a good rapport with patients and everything runs smoothly, but unfortunately, there are patients who can make your work more challenging than it already is.
Dealing with angry patients and family memberspadma puppala
Angry patients can evoke fight or flight responses in medical professionals. Inability to diffuse situation in a professional manner can lead to disastrous consequences. Here are few tips to effectively diffuse the situation
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.
Do you want bad patient relations? Do you want to lose patients? Do you want to fail your patient satisfaction surveys? Do you want a non professional image? Do you want to reduce the number of new patient referrals? Do you want to demonstrate poor quality care? Do you want to jeopardize participation in healthcare plans?
We can Help you :)
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
Mastering the HCAHPS by providing patients more than customer service, engage them in a customer experience. The audience was doctors and nurses, but the lessons apply to all hospital staff.
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.
Importance of communication for hospital Part-1 or Healthcare communication. There are 6 stakeholders are there for a hospital. How it varied from one to another we have tried to figure out. The current slide is on nursing & their challenges for communication. Mostly 60% of the problems could be solve with the proper communication.
The therapeutic interaction between the nurse and the client will be helpful to develop mutual understanding between two individuals.
Interaction is a learning experience for both client and for the nurse and a corrective emotional experience to the client to modify his behaviour.
A short sharing on doctor-patient communication to First year medical students in Universiti Malaysia Sarawak, to be supplemented with anecdotal accounts.
Mastering the HCAHPS by providing patients more than customer service, engage them in a customer experience. The audience was doctors and nurses, but the lessons apply to all hospital staff.
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.
Importance of communication for hospital Part-1 or Healthcare communication. There are 6 stakeholders are there for a hospital. How it varied from one to another we have tried to figure out. The current slide is on nursing & their challenges for communication. Mostly 60% of the problems could be solve with the proper communication.
The therapeutic interaction between the nurse and the client will be helpful to develop mutual understanding between two individuals.
Interaction is a learning experience for both client and for the nurse and a corrective emotional experience to the client to modify his behaviour.
we communicate when we talk and also when we don't talk. the sharing of ideas, thoughts, perceptions, belief between two individuals (client and nurse) which will help nurse to provide effective care and treatment to the client.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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
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
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
2. Objectives
Recognize and describe the patient and provider roles
in difficult relationships
Describe a framework (mnemonic) to improve
communication with patients and overcome challenging
interactions
3. What is a difficult patient?
One who…
Raises negative feelings within the clinician
Causes the clinician to experience self-doubt
(threatens clinician’s competence or control)
Has beliefs, values, or characteristics that differ
from those of the clinician
Does not assume the role expected by the health
care professional
A difficult patient is one who impedes the clinician’s
ability to establish a therapeutic relationship, but…
4. … It Takes Two!
The difficult patient must be viewed in context of the
clinician and the clinician-patient relationship.
Physicians:
Receive biomedical training, focused on
identification and treatment of the disease
May not receive adequate psychosocial training,
focused on communication and relationshipbuilding
Often have negative emotional responses to
patients that are not fully recognized and lead to
unconstructive behaviors
5. If the clinician feels threatened leads to over
control of the interview or situation
If the clinician has discomfort with psychological
issues leads to avoidance
If the clinician dislikes the patient leads to
superficial behavior
The most common element of an adversarial
clinician-patient relationship is
FAILED COMMUNICATION.
6. Obstruction in communication
•Multiple symptoms involving multiple body systems
•Vague and shifting complaints
•Undue concern about minor symptoms
•Poor response to usual methods of treatment
•Hostile, demanding, dissatisfied
9. The “ANGRY Patient”
Pay attention to pre-visit signs: long waits and staff
cues.
Is it true anger, or just pain and frustration?
Anticipation of Bad News?
DO NOT GET DRAWN INTO THE CONFLICT
KNOW YOUR TRIGGERS!
10. Strategies to Defuse Anger
1.
2.
3.
4.
5.
6.
7.
Allow the patient to vent their anger.
Acknowledge the anger “I can see you are really
angry about this.”
Validate the anger “understandably you are very
angry as this is a very frustrating situation you are
in.”
Offer to explore the situation in more depth – it is
often found that there are many layers to the anger
and frustration the patient is experiencing.
During the interchange keep calm
Use a neutral tone of voice, adopt an open body
posture
Do not become defensive (do not take it personally)
11. Non-Compliant Patients Defined
The patient deviates significantly from most patients (with
similar medical problems) in degree of compliance with
medical advice, treatment, or follow-up in a way that
directly or potentially jeopardizes the patient's health or
quality of life.
The patient's medical problem is potentially serious and
poses a clinically significant risk to length or quality of life
At least one treatment exists that if followed correctly, will
markedly reduce this risk
The patient has easy access to the treatment or
treatments
12.
“The most helpful things I have ever done with
noncompliant patients have been to ask questions,
not to lecture, and to be willing to listen to what
patients say.
These activities are often very difficult to do within
the time constraints of clinical practice.
Sometimes I have to "suspend" the clock and my
usual clinical approach and just tell the patient that
I'm frustrated and concerned and that I need to know
what he or she understands about the disease
process and problems being faced. And then I'll just
be quiet and listen as nonjudgmentally as possible. “
14. The “Seductive Patient”
Even non-psychiatric care involves “transference”
phenomenon
Transference=feelings experienced by the patient toward
the physician that recapitulate other important
relationships within the patient’s life
Caring and compassion misinterpreted as sexual
suggestion
Innocent flirtations NEVER appropriate
Emphasize that this is a strictly professional relationship
Utilize chaperone throughout interactions
Obtain consultation/referral if needed
Institute and enforce written office guidelines
15. The “MANIPULATIVE” Patient
These patients often play on the guilt of others,
threatening rage, legal action or suicide.
They tend to exhibit impulsive behavior directed at
obtaining what they want, and it is often difficult to
distinguish between borderline personality disorder and
manipulative behavior.
The keys to managing encounters with manipulative
patients are to be aware of your own emotions, attempt
to understand the patient's expectations (which may
actually be reasonable, even if his or her actions are not)
and realize that sometimes you have to say "no."
16. Case One
R.D. is a 5 year old girl with lobar pneumonia and effusion,
hospitalized with respiratory distress and hypoxia. You are called
to her bedside because of worsening respiratory status. On exam,
she appears ill and uncomfortable. She is febrile, tachypneic, with
diminished breath sounds on the right base and both subcostal and
intercostal retractions. Her parents, whom you have never met,
are at the bedside and appear worried.
What is the goal of communication with the patient and parents?
What are the challenges of communicating with the patient and
parents in this situation?
17. Unique challenges to effective
communication
Inherent stress of high acuity situation
Lack of established relationship with patient and parents
Potential for frequent interruptions
Time constraints
And more…
18. Doctor-Patient-Attendant Communication
Informativeness: quantity and quality of health information
provided by doctor. It directly addresses the cognitive needs of
the patient and/or parent, and forms the foundation for the
physician’s task-related behavior. The physician may say, “She
may have respiratory distress because her effusion has worsened,
so I am going to get a chest x-ray.”
Interpersonal sensitivity: affective behaviors that reflect the
physician’s attention to, and interest in, the patients’ and
relatives feelings and concerns
Partnership building: the extent to which the physician invites
the parents (and child) to state their concerns, perspectives, and
suggestions
19. Interpersonal sensitivity and partnership building
address the affective needs of the patient and/or the
relative-that is, the emotional need to feel heard and be
understood.
These two components inform the physician’s relational
behavior – showing concern and respect. The physician
may say, “I can see that you are worried. What worries
you the most?”
20. Some nonverbal ways to show concern and
respect include maintaining eye contact, using
appropriate gestures, and using active listening
skills.
The literature overwhelmingly supports direct
communication with the child, provided that the
communication is done in a developmentally
appropriate manner, taking into account the
parent-child relationship and the family’s cultural
values.
21. Case Two
You finally have a moment to eat dinner. Your
phone rings and the nurse on duty says: “Patient
J.S.’s mother is here. She is upset and asking to
speak to the doctor. Please come ASAP.”
You groan in response. Mrs. S has become
notorious on your team, a so-called “difficult
relative,” because she is always upset and
demanding of the provider’s time. You have been
dreading receiving this page. You decide to eat your
dinner quickly, and then go to the bedside.
22. Which characteristics of the patients relative and provider
contribute negatively to this situation?
What approach would you use when talking to Mrs. S?
Case Two- Continued
You review your sign-out: J.S. is a 4 month old with
bronchiolitis. Parents were not present or reachable by
phone during day. You learn from the nurse that Mrs. S is
upset because J.S. was placed on oxygen and she was not
notified.
23.
When you walk into the room, Mrs. S has her arms
folded across her chest. You introduce yourself, and
she responds by complaining about her son’s care and
how no one is talking to her. You listen for a minute or
two, and end up having to interrupt her to get a word in.
You mention that your colleague called during the day
but no one answered. Mrs. Smith just gets more upset,
saying that there was no message and no one is
keeping her informed.
24. What is the goal of the provider’s interaction with
Mrs. S?
Alleviate parent concerns, provide education
about condition and what to expect, establish
better method of communication
How is this goal best accomplished?
Active listening, validation of concerns
25. NURS Mnemonic
Goal: Elicit the patient’s emotions and address them.
Naming: recognition of emotion
Understanding: acceptance and validation of emotion
“I can understand why that was frustrating for you.”
Respecting: respect their experience, praise their efforts
“You are angry.” or “That was sad for you.”
“You’ve been juggling a lot.” or “You did a great job recognizing that
he was getting more sick.”
Supporting: express support, create partnership
“Let’s work together to come up with a better way to address this.”
26. Case Two- Revisited
Using the NURS mnemonic, craft a
response to Mrs. S.
“Mrs. S, I can see that you are upset and I can understand why. It must be
difficult to arrive at the hospital and learn that your son is now requiring
oxygen. You’ve been juggling a lot, with having to go to take care of your
other children and be here at the hospital with J.S. What questions can I
answer for you now?
I am sorry that we were not able to communicate better during the day.
What would be the best way to make sure this type of thing doesn’t
happen again?”
27. Coping Skills that help…
Allow patients to vent their feelings: Listen long
enough to show your empathy, but set practical time limits.
Strengthen your communication skills: Remember
that as a physician, you're also a teacher and a coach.
Tailor your explanations and guidance to each patient's
needs and ability to absorb information.
Become a more effective history taker: They may also
provide you with clues about what the patient is skipping
over or not saying.
Avoid becoming an enabler: Know when to set limits on
patients' demands in order to protect yourself from burnout
28. Try not to judge: View patients' disruptive actions as
opportunities to learn more about their concerns, beliefs and
needs.
Remain calm and confident: Stay in control while working
with patients who are angry, depressed, manipulative,
seductive or overly dependent.
Understand your own strengths and vulnerabilities:
Know when to set limits on patients' demands in order to
protect yourself from burnout
Be patient & Respect your patients: Know when to set
limits on patients' demands in order to protect yourself from
burnout
Protect patients' confidentiality, keep promises and show that
you respect their feelings.
Editor's Notes
Teacher’s Guide:
Common characteristics and circumstance of patients perceived to be difficult by providers:
Emotional and expressive of emotions
Certain personality features or disorders
Personal characteristics viewed negatively by provider (different moral or ethical view points, non-English speakers, disheveled or unkempt appearance)
Specific clinical problems
Places extra demands or stresses on the clinician
Teacher’s Guide:
Literature supports notion that most learners can be taught awareness of negative responses and harmful behaviors. Communication skills training can improve an individual’s ability to communicate in difficult situations.
Pay special attention to the final point -- physicians often have negative emotional responses to patients that are not fully recognized and lead to unconstructive behaviors. Some examples are listed below. Have the learners reflect on these patterns. Do they recognize these behaviors in themselves or others?
Teacher’s Guide:
Have the learner(s) read through the scenario. Ask for a volunteer to describe how they would approach a conversation with R.D’s parents.
Ask and discuss:
What is the goal of communication with the patient and parents? (build trust, gather data, give information)
What are the challenges of communicating with patient and parents in this situation?
Teacher’s Guide:
Some challenges to effective communication with patients and parents while in the night float role are listed here. Are there others?
Some others to consider:
Less time to spend with each patient due to higher patient load at night
On call physician may have limited information about the patient available
Exhaustion (patient, parent, physician, etc.)
Teacher’s Guide:
There are three basic components to physician-parent-child communication, listed here. “informativeness” refers to the quantity and quality of health information provided.
Teacher’s Guide:
Have the learner(s) read through the scenario. Ask learners to share (quickly) personal experiences with a “difficult patient or parent,” and/or consider offering an example from your own experience.
Ask the learners to. For example, the parent is reportedly upset/angry/emotional and demanding; The provider has a negative perception/energy in advance of the meeting and is demonstrating avoidance behavior.
Facilitate a discussion around the following questions:
What additional information do you need to know before meeting Mrs. S?
What approach would you use when talking to Mrs. S?
Teacher’s Guide:
Ask the learners how they would feel in this situation.
Facilitate a discussion about possible approaches and/or responses to Mrs. S’s concerns. What is the goal of the interaction and how is that goal best accomplished?
Goal:
Approach: and more… see following slides
Teacher’s Guide:
The NURS mnemonic can provide a framework for approaching communication with an angry or difficult parent.
Teacher’s Guide
Ask the learners to think back to Case Two. Ask them to use the NURS mnemonic to generate possible responses to Mrs. S.
One example of a response, using the NURS mnemonic, is given.