Professional Documents
Culture Documents
Understand the psychological and personal impact of illness, disability or sudden death and be able to communicate sensitively with patients and relatives
You are a FY1 on a Care of the Elderly ward. One of your patients, Stanley Smith, was declared nil by mouth due to dysphagia, pending a SALT assessment. Unfortunately there was a miscommunication and Stanley was allowed to eat a sandwich. He aspirated and developed a pneumonia. Stanleys niece, Anita, would like to speak to you about this. Firstly she is very upset that he was deprived of food and drink. She overheard one of the nurses telling a colleague about the mistake and is quite angry that this has happened and nobody has told her about it.
Complaints
Establish who you are talking to and how you can help Allow them to talk and vent their anger. Acknowledge this Encourage them to speak, ask open questions, empathise Apologise for the mistake Explain what will happen next i.e to resolve the situation If the patient/relative remains unhappy with your apology and explanation, explain that they can talk to a more senior doctor/nurse or PALS if they wish
Counselling
E.g explaining a procedure such as OGD/colonoscopy, AAA counselling, blood transfusion, C Diff/MRSA, AF + warfarin
Find out what the patient already knows, and what they want to
know Offer information in manageable chunks, avoid jargon Check understanding as you go You could use diagrams Offer written information
AF + warfarin counselling
Check knowledge of AF, explain what it is Explain need for anticoagulant (i.e stroke risk in certain individuals) Check knowledge of warfarin Explain bleeding risk and need to monitor INR Importance of compliance Avoid certain drugs, always check with Dr/pharmacist Alcohol, contact sports Yellow book: record of appointments Summarise, check understanding, written info, follow up
Preparation: Know the facts, ensure privacy and quiet place to talk Find out what the patient/relatives already know Do they want more information? Give a warning shot: Im afraid things look more serious than we first thought. Allow a pause, then break the news. Avoid jargon. Allow denial Explain, listen to concerns Encourage ventilation of feelings: I can tell that was quite a shock for you Summarise Explain what will happen next Offer support/further information/meeting with family
Summary
Practice, practice, practice Importance of a good introduction Always explore the patients ICE Space for questions and future plans
+ Any questions?