Difficult Conversations Dr Helen Morgan Macmillan Consultant Palliative

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Difficult Conversations Dr Helen Morgan Macmillan Consultant Palliative Medicine

Difficult Conversations Dr Helen Morgan Macmillan Consultant Palliative Medicine

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Difficult conversation: any situation where the needs/wants, opinions or perceptions of the involved parties

Difficult conversation: any situation where the needs/wants, opinions or perceptions of the involved parties are diverse, with their feelings and emotions running strong. Conversation: balance between talking and listening.

Difficult Conversations

Difficult Conversations

Why Difficult? • • • Unleashing strong emotion Damaging the patient or making things

Why Difficult? • • • Unleashing strong emotion Damaging the patient or making things worse Facing difficult questions Taking up too much time Concerns about personal survival Facing one’s own failure when unable to problem solve & fix

Communication • Not just “being nice” – More effective consultation for both patient and

Communication • Not just “being nice” – More effective consultation for both patient and doctor – Bridges the gap between evidence-based medicine & working with individual patients

Burnout & emotional burden • Communication skills training • Associated with high empathy

Burnout & emotional burden • Communication skills training • Associated with high empathy

Communication Models

Communication Models

“ Just cut to the wick doctor… are you saying she’s dying? ? ?

“ Just cut to the wick doctor… are you saying she’s dying? ? ? ”

“Thank you doctor, I thought she was dying but kept being told she was

“Thank you doctor, I thought she was dying but kept being told she was getting better”

1. Be prepared • • • Mentally Practically Are you the right person? ?

1. Be prepared • • • Mentally Practically Are you the right person? ? ? IS this the right time? ? ? Possible solutions

2. Timing • Blunt • Forecasting • Avoidant

2. Timing • Blunt • Forecasting • Avoidant

3. Honesty • If you don’t know, say you don’t • Acknowledge uncertainty •

3. Honesty • If you don’t know, say you don’t • Acknowledge uncertainty • Don’t equate your experience/perspective with theirs

4. Listen

4. Listen

5. Skill • Practice, practice • Rewarding to do well • Better for patients,

5. Skill • Practice, practice • Rewarding to do well • Better for patients, carers • Better for you as an individual

helen. morgan 2@christie. nhs. uk

helen. morgan [email protected] nhs. uk