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Delivering Bad News When Unanticipated Events Occur Restoring Control in an uncontrolled moment.

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Presentation on theme: "Delivering Bad News When Unanticipated Events Occur Restoring Control in an uncontrolled moment."— Presentation transcript:

1 Delivering Bad News When Unanticipated Events Occur Restoring Control in an uncontrolled moment

2 This is how CNN describes us in the media.


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

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


7 A bridge to those we love Where to start?

8 Maintaining that bridge….

9 Technology has elevated patient expectations

10 Is this not a beautiful baby?

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


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

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!

15 Coombs 1993 Medical SchoolResidencyFellowPractice Pre Med Do we shield ourselves at the expense of our patients?

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

17 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. Are we appreciated by our patients? Sometimes

18 If you, the patient, dont talk about it, because I, the physician, dont ask, you wont think about it. If you dont think about it, you will forget. Conspiracy of Silence Lewis, 1979



21 Strategies for care during the initial hospitalization See the patient twice a day. FIND THE TIME. Use the babys 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)

22 Letters say it all. The 10 minute chat Im sorry your family is going through such a hard time.

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

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.

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

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

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 husbands 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 babys death?

28 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.

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

30 Patient-centered rounds RESTORING CONTROL.

31 Safety Walk-Rounds Where are the near misses?

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

33 Simulated obstetric education

34 Thank you

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 Neer a word said she; But oh, the things I learned from her When sorrow walked with me. Robert Browning Hamilton

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

37 The Letter 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... Starting the process of recovery

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 Potters Syndrome.

39 In normal life, I LOVE YOU is sometimes difficult to say. I love you can mean dont 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

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.

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 cant believe its been a whole year since I last touched him, held him, heard his voice. This day had to come. Theres no way around it. So far its 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. Its hard to remember how he *felt*. Ill, 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




45 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.

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

47 Pictures are worth a 1000 Words.

48 Thank you.

49 Which setting do you use to communicate bad news?

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