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Interactive Format Four Scenarios Three Repeating Questions
› What’s Wrong Here? Patient Feels? Physician Feels?
› What Would You Do Differently?
› What Do We Suggest?
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Prepare yourself for patient in minute before entering office
› “wind up” is contagious
› “wind down” starts with physician Look at the patient. Talk slowly. Move slowly. Focus on one or two major problems
› make arrangements to see again for other problems.
The Wound Up - Gobbledygook Physician
What do we suggest?
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Speak slowly in ordinary language at patient’s level of understanding
Teach back technique (patient)
Invite a family member or friend to attend
Refer to Patient Self-Management & Health Literacy Module
What do we suggest?
The Wound Up - Gobbledygook Physician
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Look for cues in yourself of feeling angry
Check & drop your biases at door
Deliberately choose an empathic approach
Consult – you’re not alone.
Sample script
What do we suggest?
The Frustrated - Stuck Physician
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“I can see you’re still in a lot of pain. That must be so frustrating for you. It’s frustrating for me too & I don’t have your pain. I think we’re both feeling stuck.” (joining)
“Trying new strategies takes time and small steps. As I’ve explained, when you engage in paced activity you will strengthen your body so that you can do more than you’re doing now without pain flare-ups.”
“You might already know what to do but you worry about moving more because of pain or even re-injury.” (fears, catastrophizing)
“So let’s look at what part of our plan isn’t working yet.” (problem-solving)
Empathic script for frustrated physician
The Frustrated - Stuck Physician
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Do not personalize or become defensive.
Is your manner or approach off-putting?
Set boundaries & limits. Time to let go?
Do you wonder about unspoken agendas?
Sample script
What do we suggest?
The Argumentative Patient
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“You still have pain.”
“My treatment suggestions do not appear to be working for you.”
“You seem more interested in trying these other therapies.”
“You can always return.”
Script for argumentative patient
The Argumentative Patient
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What cues your urge to rescue?
Self-coaching: “What does this patient really need or want?” “Will I really help this patient by giving another round of Oxys?”
Script that is empathic & firm.
What do we suggest for the Rescuing Physician?
The Rescuing – Discouraged Physician
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“The research & my experience with this medication tells me that higher levels of these Oxys are bad for patients. This is because they lead to complications that are harmful.”
“For example, you start to notice that you have to take increased doses just to get the same effect. But soon you get less relief and then more pain.”
“If these medications allow you to move more, it makes sense to use them. Otherwise, we need to find a different plan.”
Script for Rescuing Physician
The Rescuing – Discouraged Physician
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Are you aware of feeling discouraged about this patient?
Self-coaching: “I’m feeling discouraged about this patient. How can I proceed in a more hopeful manner?”
Sample script
What do we suggest for discouraged physician?
The Rescuing - Discouraged Physician
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“Although there’s no specific diagnosis, I do believe that you have real pain.”
“All the consults and tests support your experience of chronic pain. And there are some good ways to manage that pain.”
“The best pain management will come from us working together to find the right combination of pain self-management and other treatments to support you in this.”
“For example, I doubt that you will harm yourself if you do more around the house in a paced way. And this will help you both mentally & physically to prepare for work.”
Script for Discouraged Physician
The Rescuing - Discouraged Physician
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F. Daniel Duffy et al (2004), “Assessing competence in communication and interpersonal skills,” Academic Medicine, 79(6), 495-507.
Patricia L.B. Lockyear, Dec. 9, 2004, “Physician-patient communication: enhancing skills to improve patient satisfaction.” www.medscape.com
Peter Tate (2010), The Doctor’s Communication Handbook, 6th Ed. Abingdon Oxon, Radcliffe Publishers.
L. Wen & J. Kosowsky (2012), When doctors don’t listen. NY: St. Martin’s Press.
Where to learn more
Doctor – Patient Communication