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Secretes of
Breaking
Bad News
Few tips
Director s:
Dr. Sharda Jain
I Dedicate this PPT to my
Colleagues & Patients
Review This Lecture at
slideshare.net
Professional life is like a game
Some time you win
At other time you lose
You have to take it in your
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
Do No Harm
Deliver Best to T he Patients
“Today , you will see that
MOST SUCCESSFUL DOCTORS
are those who have
Good
communication skills.
It pays to be patient to the
patients
Human Emotions are Most
Difficult to Predict ,
especially in a STRESSFUL environment
like
UNFAVORABLE DISEASE or
DEATH in a hospital
so…
Doctor need to be extra careful while talking
to patients & relatives
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.
In the CANCER WARD, families
of patients complain
• Doctors don’t offer much advice
• Alternatives are not detailed
• How to manage the debilitating pain
associated with the disease.
Concerns & Realities
“At times , physicians do end
up losing patients for being
“Rude & Uncaring”
What do you Think
is BAD NEWS ?
• What is bad news?
• How bad?
• What went wrong?
• How could it have been done better ?
• What if you were the patient or relative - how
will you take it ?
What is bad News?
It is any information which is
Likely to
ALTER DRASTICALLY
A PATIENTS VIEW
OF THE FUTURE all together …
VARIOUS IDEAS on BAD NEWS?
• Feeling of NO HOPE,
• A threat to a person’s Mental or physical well being
• A risk of Upsetting An Established Lifestyle or
• Where a message is given which conveys to an
individual fewer choices in her life
(ptacek & Eberhardt TL, 1996)
• “any news that drastically and negative alters the
patients view of her or his future” is bad news.
(Buckman, 1984)
What Constitute BAD NEWS in O/G ?
STIGMATIZATION HIV-----------------------------------------------------------------------------------------------------------------------------------
INFERTILITY
--------------------------------------------------------------
• Azoospermia
• B/L patent tubes
• IVF failure
UNFAVORABLE
DIAGNOSIS------------------------------------------- -------------------------------------------------------------------------------
Irreversible , un-treatable or non-
stoppable disease / side effects/
complications
CANCER-------------------------------------------
----------------------------------------------------------------------------------------
YOUNG AGE
Recurrence
Spread of disease
Late stage
----------------------------------------------------------------------------------------------
• STILL BIRTH
• NND in 1st
24 hrs
• Rec. Mole
• Rec. Pregnancy Los
PREGNANCY
DEATH
DEATH / DOT
Various Situations Faced by
Gynaecologists
Bad
Diagnosis
C
A
N
C
E
R
I
N
F
E
R
T
I
L
I
T
Y
Azoospremia
Still
Birth
B/L Block Tubes
DOT NND IVF failure
Death
in O/G
Rec.
Miscarriage
Endometriosis
Any of these Condition has potential to surprise the
Great gynaecologists by sudden occurrence.
This may occur in spite of taking all pro-active
precautionary measures.
Although awareness and readiness to face and tackle
all possible mishaps would minimize complications,
to a large extent.
However it cannot always be eliminated all together.
Bad News
INFORMED CONSENT
is vital for gynaecologists to fully make them
understand
Counseling / Video Recording
DEATH
on
Operation
Table
(DOT)
in O/G
is extreme rarity
DOT
80/20
It is like death in police custody where
there is no help for patient & nobody knows
the facts except doctors & their team.
DOT/ Still Birth
Arrest
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
DEATH
Obstetrics / Gynaecology
Is no joke !!!
A Gynaecologist is caught at least once in
lifetime in this tragedy !!
Real Life Incidents
Primi. had elective LSCL for breach
After smooth surgery had pulmonary
odema & died
Biggest Bombshell
Still Birth at term
or
NND in 24hrs.
Litigation + + +
Recurrent Miscarriage
Recurrent
IVF
Failures
CANCER
Young age Last stage Recurrence
REQUIRES CAREFUL HANDLING
“Ending Treatment”
Cancer Infertility Rec.
Miscarriage
When to advice patients that
“enough is enough”
Endometriosis
Cause of Litigations
is
Lack of Empathy
Lack of Communications
• Over work
• Over tired
• Explained before
Are Silly
Doctor’s
Excuses
Support Systems
• Denial
• Despair
• Anger
• Bargaining
• Depression
• Acceptance
Emotional Responses to a bad News
Breaking Bad News
is an ART
Doctors - today are
realizing that they have to
deliver Bad News
Diagnosis with care
Breaking some BAD NEWS for us!
Is the MOST DIFFICULT TASK !!
This ART – We All Have to Learn it
Soft skills of BBN are
NOT Taught
in Medical Colleges
YOU ARE LUCKY TO HAVE
GOOD BOSS / MENTOR !!
Doctors need to polish soft skills
to Deliver
“Tough”
Bad News
BLAT
• BUILD TRUST
• LISTEN ,
• APOLOGIZE,
• THANKS
“in our practice it helps us in dealing with
difficult situations and breaking bad news
Is our 1st
choice
ABCDE our second choice
A- ADVANCE PREPARATION
B- BUILD ENVIRONMENT / RELATIONSHIP
C- COMMUNICATION WELL
D- DEAL WITH REACTION
E- ENCOURAGE & VALIDATE EMOTIONS
Other Practical Approaches to BBN
SPIKES
Setting and listening skill
Patient perception
Invitation to give
Information
Knowledge
Explore Emotion &
Empathize
Strategy and summarize
BREAKS
B- BACGROUND
R- RAPPORT
E- EXPLORE
A- ANNOUNCE
K – KINDLING
S- SUMMARIZE
Practical Tips
Keep a Bold Face !!
• Preserve maintain
reasonable
EMOTIONAL BALANCE
• Preserve a satisfactory
SELF – IMAGE and
sense of Competence.
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
How to Handle The Situation…
 Gather
 Ask for help.
 Relax
 Review sequence of events
 Do not adopt a “Blame Culture”
 Proper documentation
 No discrepancies in records
 No comments by junior staff
Never worry, “Be concerned”
Communication is two way Process
Communication Skills
 Good communication by Sr. & Reputed
Consultant can prevent litigation
 RELATIVES WANT to know TRUTH
 Sympathetic approach
Anticipate Reaction of Relatives
& handle it well
 Shock
 Pain
 Anger
 Guilt
 Depression
• Avoid aggression or putting blame on
relatives
• Staff should not contradict statements
made by consultants to avoid
misinterpretation by relatives.
• Do not refuse to give records
or refuse postmortem,
rather suggest it from your side.
Communication Skills
Being Sensitive to the
Relatives
 While you proceed read the non-verbal clues;
face/body language, silence, tears
 Allow for “shut down” (when relatives turn off
& stop listening) give time & space: allow
possible denial
 Give opportunity to ask questions
 Arrangements for taking away the dead body.
 Registering the death
Strategies for coping crisis in
infertility/ IVF /obstetrics
Meaningful 1st
counseling of couple – biggest tip
Be mentally prepared to accept failure
Accept & Redefine goals
After crisis – problem focused BBN
1. EMOTIONAL DISCHARGE
2. Encourage CALM ACCEPTANCE
3. Be a PROBLEM SOLVER
4. Explain ALTERNATIVES
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”
Relaxation technique &
psycho therapeutic counseling
Helplessness
doctor you are Great !! Now - I can handle the problems
related to my infertility / Pregnancy Loss
• Help her to speak - up
• Improve decision making skill
•Advice for treatment holidays
• Problem solving skill
• Benefits of physical well – being
• Nutrition.
• Spiritual counseling
Acceptance
BBN for “Ending Treatment”
* A patient – centered emotionally
focused approach is the key
* Let the patient set the agenda
•Help them to find meaning in life ,
Assist them in redefining goals
• To promote long term adjustment
in life by examples
Last, But Not The Least…..
 Stop thinking about it constantly
 Take a small break
 Keep your morale & self confidence
intact
 Learn the lesson it teaches
Even with simplest case or operation
it can not be
taken for granted that patient
will come out
Better of or even alive
Soft Skill Workshops
Group Sharing
Role Plays
Creative workshop for Doctors &
Medical Students
to make them
• Expressive
• Empathetic
• Concerned
• But bold & self confident
Left you with many Qunanswered
ADDRESS
11 Gagan Vihar , Near Karkari Morh
Flyover Delhi -51
CONTACT US
9650511339
011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com

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

  • 1. Secretes of Breaking Bad News Few tips Director s: Dr. Sharda Jain
  • 2. I Dedicate this PPT to my Colleagues & Patients Review This Lecture at slideshare.net
  • 3. Professional life is like a game Some time you win At other time you lose You have to take it in your
  • 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. Do No Harm Deliver Best to T he Patients
  • 6. “Today , you will see that MOST SUCCESSFUL DOCTORS are those who have Good communication skills. It pays to be patient to the patients
  • 7. Human Emotions are Most Difficult to Predict , especially in a STRESSFUL environment like UNFAVORABLE DISEASE or DEATH in a hospital so… Doctor need to be extra careful while talking to patients & relatives
  • 8. Concerns & Realities Walk into the major LABOUR WARD of any government hospital, and you’re likely to find patients / relatives VERY CRITICAL with treatment given.
  • 9. In the CANCER WARD, families of patients complain • Doctors don’t offer much advice • Alternatives are not detailed • How to manage the debilitating pain associated with the disease. Concerns & Realities
  • 10. “At times , physicians do end up losing patients for being “Rude & Uncaring”
  • 11. What do you Think is BAD NEWS ? • What is bad news? • How bad? • What went wrong? • How could it have been done better ? • What if you were the patient or relative - how will you take it ?
  • 12. What is bad News? It is any information which is Likely to ALTER DRASTICALLY A PATIENTS VIEW OF THE FUTURE all together …
  • 13. VARIOUS IDEAS on BAD NEWS? • Feeling of NO HOPE, • A threat to a person’s Mental or physical well being • A risk of Upsetting An Established Lifestyle or • Where a message is given which conveys to an individual fewer choices in her life (ptacek & Eberhardt TL, 1996) • “any news that drastically and negative alters the patients view of her or his future” is bad news. (Buckman, 1984)
  • 14. What Constitute BAD NEWS in O/G ? STIGMATIZATION HIV----------------------------------------------------------------------------------------------------------------------------------- INFERTILITY -------------------------------------------------------------- • Azoospermia • B/L patent tubes • IVF failure UNFAVORABLE DIAGNOSIS------------------------------------------- ------------------------------------------------------------------------------- Irreversible , un-treatable or non- stoppable disease / side effects/ complications CANCER------------------------------------------- ---------------------------------------------------------------------------------------- YOUNG AGE Recurrence Spread of disease Late stage ---------------------------------------------------------------------------------------------- • STILL BIRTH • NND in 1st 24 hrs • Rec. Mole • Rec. Pregnancy Los PREGNANCY DEATH DEATH / DOT
  • 15. Various Situations Faced by Gynaecologists Bad Diagnosis C A N C E R I N F E R T I L I T Y Azoospremia Still Birth B/L Block Tubes DOT NND IVF failure Death in O/G Rec. Miscarriage Endometriosis
  • 16. Any of these Condition has potential to surprise the Great gynaecologists by sudden occurrence. This may occur in spite of taking all pro-active precautionary measures. Although awareness and readiness to face and tackle all possible mishaps would minimize complications, to a large extent. However it cannot always be eliminated all together. Bad News
  • 17. INFORMED CONSENT is vital for gynaecologists to fully make them understand Counseling / Video Recording
  • 20. It is like death in police custody where there is no help for patient & nobody knows the facts except doctors & their team. DOT/ Still Birth Arrest
  • 21. 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
  • 23. A Gynaecologist is caught at least once in lifetime in this tragedy !!
  • 24. Real Life Incidents Primi. had elective LSCL for breach After smooth surgery had pulmonary odema & died
  • 25. Biggest Bombshell Still Birth at term or NND in 24hrs. Litigation + + +
  • 26. Recurrent Miscarriage Recurrent IVF Failures CANCER Young age Last stage Recurrence REQUIRES CAREFUL HANDLING
  • 27. “Ending Treatment” Cancer Infertility Rec. Miscarriage When to advice patients that “enough is enough” Endometriosis
  • 28. Cause of Litigations is Lack of Empathy Lack of Communications • Over work • Over tired • Explained before Are Silly Doctor’s Excuses
  • 29. Support Systems • Denial • Despair • Anger • Bargaining • Depression • Acceptance Emotional Responses to a bad News
  • 30. Breaking Bad News is an ART Doctors - today are realizing that they have to deliver Bad News Diagnosis with care
  • 31. Breaking some BAD NEWS for us! Is the MOST DIFFICULT TASK !! This ART – We All Have to Learn it
  • 32. Soft skills of BBN are NOT Taught in Medical Colleges YOU ARE LUCKY TO HAVE GOOD BOSS / MENTOR !!
  • 33. Doctors need to polish soft skills to Deliver “Tough” Bad News
  • 34. BLAT • BUILD TRUST • LISTEN , • APOLOGIZE, • THANKS “in our practice it helps us in dealing with difficult situations and breaking bad news Is our 1st choice
  • 35. ABCDE our second choice A- ADVANCE PREPARATION B- BUILD ENVIRONMENT / RELATIONSHIP C- COMMUNICATION WELL D- DEAL WITH REACTION E- ENCOURAGE & VALIDATE EMOTIONS
  • 36. Other Practical Approaches to BBN SPIKES Setting and listening skill Patient perception Invitation to give Information Knowledge Explore Emotion & Empathize Strategy and summarize BREAKS B- BACGROUND R- RAPPORT E- EXPLORE A- ANNOUNCE K – KINDLING S- SUMMARIZE
  • 38. Keep a Bold Face !! • Preserve maintain reasonable EMOTIONAL BALANCE • Preserve a satisfactory SELF – IMAGE and sense of Competence.
  • 39. What are we worried about…? DOT/ Death/ Still Birth • Breaking the news • Damage to reputation • Facing questions of relatives • Fear of mob violence • Handling police enquiry • Medico-legal issues – arrest, courts, case, judgment… • Compensation amount • Loss of confidence • Stress in future cases
  • 40. How to Handle The Situation…  Gather  Ask for help.  Relax  Review sequence of events  Do not adopt a “Blame Culture”  Proper documentation  No discrepancies in records  No comments by junior staff Never worry, “Be concerned”
  • 41. Communication is two way Process
  • 42. Communication Skills  Good communication by Sr. & Reputed Consultant can prevent litigation  RELATIVES WANT to know TRUTH  Sympathetic approach
  • 43. Anticipate Reaction of Relatives & handle it well  Shock  Pain  Anger  Guilt  Depression
  • 44. • Avoid aggression or putting blame on relatives • Staff should not contradict statements made by consultants to avoid misinterpretation by relatives. • Do not refuse to give records or refuse postmortem, rather suggest it from your side. Communication Skills
  • 45. Being Sensitive to the Relatives  While you proceed read the non-verbal clues; face/body language, silence, tears  Allow for “shut down” (when relatives turn off & stop listening) give time & space: allow possible denial  Give opportunity to ask questions  Arrangements for taking away the dead body.  Registering the death
  • 46. Strategies for coping crisis in infertility/ IVF /obstetrics Meaningful 1st counseling of couple – biggest tip Be mentally prepared to accept failure Accept & Redefine goals After crisis – problem focused BBN 1. EMOTIONAL DISCHARGE 2. Encourage CALM ACCEPTANCE 3. Be a PROBLEM SOLVER 4. Explain ALTERNATIVES
  • 47. BBN in pregnancy / Infertility is all together different game !! “Their first reaction is disbelief, then blame and anger .. as a doctor, don’t say anything , just hold their hand and let them vent their anger . They generally come back and talk to you after a while”
  • 48. Relaxation technique & psycho therapeutic counseling Helplessness doctor you are Great !! Now - I can handle the problems related to my infertility / Pregnancy Loss • Help her to speak - up • Improve decision making skill •Advice for treatment holidays • Problem solving skill • Benefits of physical well – being • Nutrition. • Spiritual counseling Acceptance
  • 49. BBN for “Ending Treatment” * A patient – centered emotionally focused approach is the key * Let the patient set the agenda •Help them to find meaning in life , Assist them in redefining goals • To promote long term adjustment in life by examples
  • 50. Last, But Not The Least…..  Stop thinking about it constantly  Take a small break  Keep your morale & self confidence intact  Learn the lesson it teaches Even with simplest case or operation it can not be taken for granted that patient will come out Better of or even alive
  • 51. Soft Skill Workshops Group Sharing Role Plays
  • 52. Creative workshop for Doctors & Medical Students to make them • Expressive • Empathetic • Concerned • But bold & self confident
  • 53. Left you with many Qunanswered
  • 54. ADDRESS 11 Gagan Vihar , Near Karkari Morh Flyover Delhi -51 CONTACT US 9650511339 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com