Talking with relatives (also about limiting therapy)

Everyday you are communicating with relatives about their loved ones development. One would expect us to have some training in the necessary communication skills, but hey: we haven’t. So we play through one of our standard situations (lol with big bleed, not too bad, yet bad prognosis).

As for reference I highly recommend the following link to a script for communication skills training for ICU residents.

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Breaking bad news

Starting with a semi-bad news – the diagnosis of MS – we’ll roleplay through the standard situation of telling and explaining the diagnosis to the patient on the ward.

I am a happy user of the Cambridge-Calgary-Guide for Communication Skills and use the chapter on Breaking Bad News from the book “Skills for Communicating with patients” as a guide, although there is certainly plenty of literature on the subject.

There is one specific point that leaves much room for individual style – namely “Gauge how much the patient wishes to know”. We discuss the most prevalent approaches, including

  • Stepwise: Offer euphemisms of increasing clarity
  • Once and for all: Start with the diagnosis and see what the patient makes of it
  • Introduce the news with a sentence such as “If the diagnosis turns out to be serious how much detail do you want to know?”

There is even a recent article on Bad News in Neurology: Communication and neurology – bad news and how to break them

The opening phase of the patient interview

Yesterday, we started a small series on communication skills using the best book ever on the subject

We used the first 45 seconds of a student interview with a patient, concentrating on

  • the open-closed cone
  • the 6-tier structure of the patient encounter according to Kurtz/Silverman
  • ways to improve the patient-doctor relationship

In our internal CME repository, I left a copy of a script on communication skills for reference.