Transcript The Anxiety Disorders Some Practical Questions & Answers

Critical
Conversations
Some Practical Communication
Strategies to Use in the Context of LifeAltering Illness1,2
A Presentation for RehabCare™
Education Day
Kendall L. Stewart, M.D.
June 12, 2007
Why is this important?
• Communication is hard.1,2
• After mastering the information
in this presentation, you will be
• Even under ideal conditions,
able to
effective communication is a
– Specify three of the typical
considerable challenge.
barriers to “normal”
• In stressful circumstances, it is
communication,
nearly impossible.
– Identify three of the common
• But those who care for people
barriers to communicating
with life-altering illness face this
successfully with people with
life-altering illness,
challenge every day.
– Describe three practical
• There are some practical
strategies for communicating
strategies that can transform
effectively during critical
our critical conversations with
conversations with seriously-ill
troubled people into moments of
patients and their families,
–
–
–
–
Reassuring clarification,
Mutual understanding,
Shared insight, and
Informed commitment.
• But just knowing what to do is
never enough.
– Explain why these approaches
make sense, and
– Explain how to use them
effectively during your
interactions with your patients.
What are some of the “normal”
barriers to effective conversation?
•
•
•
•
•
•
•
•
•
Bad timing
Distraction1
Emotional arousal
Misunderstanding
Irrational belief
Defensiveness
Disinterest
Insensitivity2
And so on
What are some additional barriers when attempting to
communicate with patients with life-altering illnesses?
•
•
•
•
•
•
•
•
•
Cognitive impairment
Denial
Disinterest
Fatigue
Irrational beliefs
Fear
Family conflict1,2
Pain
And so on
What are some practical strategies for
conducting successful critical conversations?1,2,3
• Observe your patients and their
families closely.
• Sit down.
• Ask whether this is a good time.
• If not, set up an appointment.
• Listen long and hard.
• Make a list of all of their
questions first.
• Ask permission to speak.
• Identify and accept their
feelings.
• Begin with your goals and
concerns.
• Urge them to interrupt.
• Recommend that they make a
list of questions before your
next visit.
• Use language they understand.
• Acknowledge their professional
knowledge.
• Ask someone to take notes.
• Stop and ask if you are making
sense.
• Ask the patient (or family) to
select a representative.
• Invite them to seek as many
opinions as they wish.
• Summarize your major points.
• Thank them for the opportunity
to serve them.
• Invite them to call you with any
concerns.
Invite them to seek as many
opinions as they wish.
• Why should you?
– It allows you to practice
humility.1
– It acknowledges preexisting
and strongly-held differences of
opinion.
– It highlights the difference
between evidence-based
positions and expert opinions.2
– It allows you to gently transfer
the responsibility for their
actions to them.
– It avoids conflict and
encourages trust and
commitment.
• How can you?
– “I want you to be as well
informed as possible.”
– “I want to assist you in every
possible way to make the best
possible decision—for you and
your family.”
– “While I work hard to stay
abreast of the latest significant
developments in my field, I urge
you to consult with other
recognized experts.”
– “I urge you to seek second, third
and even forth opinions, but at
some point you will tire of
differing opinions.”
– “I want what’s best for you even
if that means you choose
someone else as your
consultant.”
What have we learned?
• Communication is hard.
• Communication in the context of lifealtering illness is particularly so.1,2
• There are some approaches we can take
that will help.
• Knowing what to do in life is surely not
the same as doing it.
• But knowing what to do is a good start.
Where can you learn more online?1
• Download and read an excellent
monograph by the Australian
Government National Health and
Research Council, “Communicating with
Patients: Advice for Medical
Practitioners,” (2004) at
http://www.nhmrc.gov.au/publications/sy
nopses/e58syn.htm.
1Please
visit www.KendallLStewart.com to download related White Papers and presentations.
Where can you learn more?1
• Carnegie, Dale, How to Win Friends and
Influence People, 1937
• There is a reason why this book remains
a classic. Read it and see why. When you
have read it and reflected on it, ask
yourself why so few of us can bring
ourselves to use these principles in our
everyday interactions with others.
1Please
visit www.KendallLStewart.com to download related White Papers and presentations.
How can you contact me?1
Kendall L. Stewart, M.D.
VPMA and Chief Medical Officer
Southern Ohio Medical Center
President & CEO
The SOMC Medical Care Foundation,
Inc.
1835 27th Street
Suite B01
Portsmouth, Ohio 45662
740.356.8153
[email protected]
[email protected]
www.somc.org
www.KendallLStewartMD.com
1All
speaking and consultation fees are contributed to the SOMC Endowment Fund.
Are there other questions?
www.somc.org
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