A Presentation for RehabCare™ Education Day Critical Conversations Some Practical Communication Strategies to Use in the Context of Life- Altering Illness 1,2 A Presentation for RehabCare™ Education Day Kendall L. Stewart, M.D. June 12, 2007

Why is this important? Communication is hard. 1,2 Even under ideal conditions, effective communication is a considerable challenge. In stressful circumstances, it is nearly impossible. But those who care for people with life-altering illness face this challenge every day. There are some practical strategies that can transform our critical conversations with troubled people into moments of –Reassuring clarification, –Mutual understanding, –Shared insight, and –Informed commitment. But just knowing what to do is never enough. After mastering the information in this presentation, you will be able to –Specify three of the typical barriers to “normal” communication, –Identify three of the common barriers to communicating successfully with people with life-altering illness, –Describe three practical strategies for communicating effectively during critical conversations with seriously-ill patients and their families, –Explain why these approaches make sense, and –Explain how to use them effectively during your interactions with your patients.

What are some of the “normal” barriers to effective conversation? Bad timing Distraction 1 Emotional arousal Misunderstanding Irrational belief Defensiveness Disinterest Insensitivity 2 And so on

What are some additional barriers when attempting to communicate with patients with life-altering illnesses? Cognitive impairment Denial Disinterest Fatigue Irrational beliefs Fear Family conflict 1,2 Pain And so on

What are some practical strategies for conducting successful critical conversations? 1,2,3 Observe your patients and their families closely. Sit down. Ask whether this is a good time. If not, set up an appointment. Listen long and hard. Make a list of all of their questions first. Ask permission to speak. Identify and accept their feelings. Begin with your goals and concerns. Urge them to interrupt. Recommend that they make a list of questions before your next visit. Use language they understand. Acknowledge their professional knowledge. Ask someone to take notes. Stop and ask if you are making sense. Ask the patient (or family) to select a representative. Invite them to seek as many opinions as they wish. Summarize your major points. Thank them for the opportunity to serve them. Invite them to call you with any concerns.

Invite them to seek as many opinions as they wish. Why should you? –It allows you to practice humility. 1 –It acknowledges preexisting and strongly-held differences of opinion. –It highlights the difference between evidence-based positions and expert opinions. 2 –It allows you to gently transfer the responsibility for their actions to them. –It avoids conflict and encourages trust and commitment. How can you? –“I want you to be as well informed as possible.” –“I want to assist you in every possible way to make the best possible decision—for you and your family.” –“While I work hard to stay abreast of the latest significant developments in my field, I urge you to consult with other recognized experts.” –“I urge you to seek second, third and even forth opinions, but at some point you will tire of differing opinions.” –“I want what’s best for you even if that means you choose someone else as your consultant.”

What have we learned? Communication is hard. Communication in the context of life- altering illness is particularly so. 1,2 There are some approaches we can take that will help. Knowing what to do in life is surely not the same as doing it. But knowing what to do is a good start.

Where can you learn more online? 1 Download and read an excellent monograph by the Australian Government National Health and Research Council, “Communicating with Patients: Advice for Medical Practitioners,” (2004) at nopses/e58syn.htm. nopses/e58syn.htm 1 Please visit to download related White Papers and presentations.

Where can you learn more? 1 Carnegie, Dale, How to Win Friends and Influence People, 1937 There is a reason why this book remains a classic. Read it and see why. When you have read it and reflected on it, ask yourself why so few of us can bring ourselves to use these principles in our everyday interactions with others. 1 Please visit to download related White Papers and presentations.

How can you contact me? 1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc th Street Suite B01 Portsmouth, Ohio All speaking and consultation fees are contributed to the SOMC Endowment Fund.

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