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Delivering Bad News When Unanticipated Events Occur

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Presentation on theme: "Delivering Bad News When Unanticipated Events Occur"— Presentation transcript:

1 Delivering Bad News When Unanticipated Events Occur
Restoring Control in an uncontrolled moment QMC QMC All Rights Reserved. © 2005 Quality Medical Communications, LLC

2 This is how CNN describes us in the media.


4 medical community knows
What the medical community knows Outcome measures Length of stay Infection rates What the patient and family understand Parking issues Quality of meals Courtesy Cleanliness Problems lead to ANGER! QMC

5 What is so frightening is how easily communication can be
misinterpreted. QMC


7 A bridge to those we love
Where to start? QMC QMC

8 Maintaining that bridge….

9 Technology has elevated patient expectations

10 Is this not a beautiful baby?

11 And the journey begins…
The most Important Picture? Say hello to Bobby! And the journey begins… QMC QMC


13 Like leaves floating down a stream, hearing bad news creates a sense of loss of control.
This is the origin of ANGER! Effective communication restores that control and can reduce the anger. QMC

14 DELIVERING BAD NEWS Why am I so anxious? I did not do it. What will be
their response? How will they react? Silence? Crying? Anger? No threat to me. Did I miss something? Will they be angry at me? Have I lost their trust? I really feel guilty. They could sue me! QMC

15 Do we shield ourselves at the expense of our patients?
Pre Med Medical School Residency Fellow Practice Coombs 1993 QMC

16 18 seconds Are We Good Listeners? Time from initial patient
statement of complaint until interruption by care provider—Are we our own worst enemy? Beckman 1984 QMC

17 Are we appreciated by our patients? Sometimes
Patient – Are you a psychologist? Me - No, I am an obstetrician. Why do you ask? Patient – Because you are asking me all these things about my feelings. Me – Why does that surprise you? Patient – Because I thought all obstetricians just came in, did their thing, and went about their business. QMC

18 Conspiracy of Silence Lewis, 1979
If you, the patient, don’t talk about it, because I, the physician, don’t ask, you won’t think about it. If you don’t think about it, you will forget. Lewis, 1979 QMC

19 QMC


21 Strategies for care during the initial hospitalization
See the patient twice a day. FIND THE TIME. Use the baby’s name in the conversation. Allow the family to create the “rules:” Seeing and touching the baby. A memory box. Participation of sibs or grandparents. Pictures, wrist bands, blanket. Special requests (circumcision, time) QMC

22 “I’m sorry your family is going through such a hard time.”
The 10 minute chat Letters say it all. QMC QMC

23 Advise patients to be prepared for awkward moments once they get home.
The grocery store Church Their children’s school The neighborhood gas station Neighbors QMC

24 When an unanticipated adverse event occurs
in the hospital, always bring the patient and her family back in the FIRST week after discharge to review the details of the event and the follow-up. AVOID MEDICAL TALK. TALK TO THE ISSUES. Later steps: Review the autopsy when available. QMC

25 If anger reflects loss of control,
do you know the agenda? The safe target for anger! QMC

26 I’m her sister. Did someone make a mistake? DID I MISS ANYTHING?
She did not take care of herself! I failed my baby. DID I MISS ANYTHING? I’m her mom. Who will talk to me about my feelings? QMC QMC

27 Questions to Ask at First Office Visit
How did they treat you in the hospital? Should more have been done to help you then? How did it feel to go home? What was the hardest part for you? Have you had awkward encounters? What were the responses of family members? How did your husband’s co-workers react? Have similar past events occurred? How did you respond to them? Who is your main support person? What do you think caused your baby’s death? QMC

28 A Strategy for Delivering Bad News
THE “FEARED” ACRONYM A Strategy for Delivering Bad News State the FACTS. Discuss the case. Express EMPATHY. Search for sources of ANGER. Tell the truth. Have the patient REPEAT back your explanation. Evaluate the EXTENDED family response. DOCUMENT the conversation and next steps. QMC

29 Physician/nurse certification of EFM TeamStepps Chain of Command
Chart/Tracing reviews Ob rapid response team QMC

30 Patient-centered rounds

31 Where are the near misses?
Safety Walk-Rounds Where are the near misses? QMC

32 The Debriefing Session
21 Year old has cardiac arrest on OR table during CS. QMC

33 Simulated obstetric education

34 Thank you QMC

35 I walked a mile with pleasure, She chattered all the way;
But left me none the wiser For all she had to say. I walked a mile with sorrow And Ne’er a word said she; But oh, the things I learned from her When sorrow walked with me. Robert Browning Hamilton QMC

36 Men women Hearing bad news. EDC 6 MONTHS 1 YEAR QMC

37 The Letter Starting the process of recovery Dear Jimmy,
I am writing this letter to tell you of the hopes and dreams that your dad and I had for you, but were never able to tell you. We had made a lot of plans . . . QMC

38 “The hour I spent with Nicholas before he died was a cherished gift I will never forget. During that hour, I dressed him in baby clothes I had made. And then as they took away the tubes, I said I love you. And then he died.” M. Det., mother to a newborn male who died at one hour with Potter’s Syndrome. QMC

39 Sometimes it means hello, and sometimes, sadly, goodbye.
In normal life, “I LOVE YOU” is sometimes difficult to say. “I love you” can mean “don’t ever leave me” and also “I have to let you go now.” Sometimes it means hello, and sometimes, sadly, goodbye. Cox News Service. When words fail, simply say this: I love you. 9/17/01 QMC

40 M.Det is a 32-year-old G2P1 who, at 28 weeks gestation, was found to carry a male fetus with renal agenesis. After several lengthy discussions, she and her husband chose to have a cesarean section, knowing full well that this condition is 100 percent lethal. QMC

41 A year ago today, my baby died.
A year ago today, around 9:15 in the morning, I held him in my arms, at home, and watched him stop breathing. And cried, and felt scared, and felt relief, and felt pain that is indescribable. I can’t believe it’s been a whole year since I last touched him, held him, heard his voice. This day had to come. There’s no way around it. So far it’s not much more horrible than the 364 before it without Aaron. The worst part is the passage of time. It just gets farther and farther away from the time when Aaron was with us. It’s hard to remember how he *felt*. I’ll, of course, never forget Aaron, my little Bubby. Life goes on, and so do his memories. He changed my life forever. He was a special, beautiful, sensitive, loving, wonderful child. Thanks for listening. On the Internet 3 June 1994 QMC




45 Delivering Bad News When Unanticipated Events Occur
DISCLAIMER The information contained in this presentation and accompanying materials is designed and intended for educational training purposes. It does not constitute risk management or legal advice. For such advice, consult with an institutional risk manager, general counsel, or individual legal advisor. QMC All Rights Reserved. © 2005 Quality Medical Communications, LLC

For further information about this, or other Quality Medical Communication products, please contact - QUALITY MEDICAL COMMUNICATION, LLC 272 Duncaster Road Bloomfield, CT 06002 Telephone: (860) FAX: (860) QMC

47 Pictures are worth a 1000 Words. QMC QMC

48 Thank you. QMC

49 Which setting do you use to communicate bad news? QMC QMC

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