How can you prepare for a difficult patient conversation?

I find that speaking to a colleague before a difficult patient conversation is often helpful to me. It gives me a chance to work out my own feelings so I can go in and be 100% devoted to my patient's feelings, reactions, and questions. Remember not to make assumptions about what the news will mean to the patient -- don't frame it as 'good news' or 'bad news'. Be clear. Be concise. And then listen intently, answer questions honestly, and be empathetic. Offer to be there for follow up questions if possible. And then respond if they reach out, and promptly.

Are you planning on just breaking the bad news and then setting a short follow-up to develop a plan or are you doing both in one appointment? Or will you let the patient dynamic drive how far you take that first appointment? Or are you the starting point on the journey and the next steps will be planned by another physician/surgeon? I think it depends on the type of news as well as your previous patient relationship (I have a different goal as an ER doc than as a family doc). It’s hard to make blanket statements in these cases.

You should be aware of what might hurt and come as blunt and what might come off as non serious. Be sure to go through what you want to convey and be truthful

Best strategy is to assess the situation first, make sure the place you chose to sit and discuss is least distractive, try to open the conversation on as positive note as possible. Keep checking the reaction of the other party, active listening is a key element and to check their prior understanding, have an engaging conversation, give necessary pauses to give time to comprehend on both ends, show empathy, try to see things from patients perspective and be non judgemental, offer support and if conversation is not going as planned try giving resources online and re arrange for a follow-up meeting, encourage the patient to bring someone they trust to broader view point. Offer solutions and let patient decide.

Be sure to pay heed to patients and family members emotional reaction. Try to avoid giving news in public view and ask for who would they want to listen together as well.

EMS providers: we don’t get to choose the “right time and place”. Instead, focus on gentle honesty so the “denial” phase can start. As I buckle the older soon-to-be-widow into the front seat, she asks, “How is he doing?” Remember, we are the dealers in unexpected grief. My hospice training taught me people need honesty. They also need clarity, but in the short micro-moments of an emergency we have very little of that to give. My reply, “We’re doing everything we can, but his heart is just not cooperating.” It’s honest and as gentle as possible under the circumstances. Rehearse some of these ahead of time. It will help with the goal of never telling a lie. Lies are easier for us but cruel to the family.

Active listening is crucial to having good communication with a difficult patient. It involves being there, being present with every fibre of your being with a view to deducing plausible line of action to providing health service solution for the patient.

One great thing which might be highly relevant to communicate in the Indian context is the ability to talk the patient language. When I say patient language there are essentially two things - one is obviously the native language that the patient is comfortable in understanding and conversing in. With so many different dialects and languages it is challenging to always find a match but no harm in trying to fit. The second aspect is that of toning down the entire dialogue to easy comprehension so that there is constructive implications that flow out.

Your vocabulary and mannerisms are largely judged by the patients background. Sometimes a fairly causal demeanour with little high level language is correct and others are moments for formality and complex language. It just depends on what the patient is bringing into the room.

You should not beat around the bushes and tell the truth but beware not to spook the family more than its needed and keep it in calm manner and be ready to take any reaction they might have and be empathetic

Remember to BREATHE first and foremost. This is a great place to go somewhere with beautiful scenery, sit close your eyes and truly breathe yourself into the nature of it. There you can contemplate 'honestly' how you may wish to approach the difficult conversations ahead. But also remember this, "Saying what MUST or NEED be said is what REAL and TRUE friends DO!" With grace! Sir Nicholas In Seattle 12.30.2023