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Breaking bad news on the phone

 

What the phone consultation might cover

  • Introduction
  • Identify the patient
  • Why you are ringing
  • Options
    • Now
    • Later
    • Visit/appointment/phone
  • Summarising
  • ICE
  • Empathic comment
  • (Laughter)
  • What does the patient wish to know?
    • How much?
    • How to do?
    • When?
    • By whom?
  • Dr knowledge
  • Vocabulary
  • Choices - at every stage
  • Chunk and check
  • Supporting
  • Safety-netting
  • Open questions, write a list
  • Repeat visit/consultation - a lot to take in

A roleplay of a scenario followed with doctor and patient back to back to simulate a telephone consultation without non-verbal cues. An observer fed back the behaviour that seemed effective.

After the roleplay - what went well?

  • Introduction - "what brought you to see the doctor?" > patient replayed opening gambit
  • Giving choices
    • A caring thing to say
    • Flagged as a serious consultation
  • Expressing doctor concerns re environment
    • Not ideal
    • Disadvantaged re history
  • Defining what the arrangements had been
  • Repeated checking out
  • Empathic comments - "difficult to take it all in"
  • Other family members
  • "I'm not an expert"
  • "What will you do now?"
  • Recognising that...
    • all patient questions were valid
    •  it was OK for them to ask
  • "I'm sure there will be a lot of questions...I might not be the best person to answer..."
  • Being realistic
  • Staging the information
  • "What are you going to tell your wife?"
  • Going at the patient's speed
  • Health beliefs re options

 

After the roleplay - what was difficult?

  • Contacting people
  • "Do I have cancer?"
  • Certainty/realistic
  • Lack of non-verbal cues
  • Not picking up on emotion
  • Silence
  • What to say.... what to call it
  • Doctor's housekeeping
    • A need to do something
    • Making it right
  • Denial
  • Uncertainty > equipoise
  • Collusion of anonymity
  • Clarity
  • Helman's folk model questions

 

 

 

 

 

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