Difficult consultations Flashcards
(10 cards)
Give some examples of bad news you might need to break to patients.
any illness with long term complication (diabetes)
cancers
infertility
miscarriages
counselling someone with a genetic condition
someone dying and informing relatives
Key things to do (or not to do) when breaking bad news to patients
- checking patients understanding of what is going on
- silence can be very powerful
- not overwhelming the patient with too much information
- honesty
- not guessing prognosis ‘im sure you’ll be fine’
- dont remove all hope
- confidentiality remains crucial
- private area and space
- not being far apart from the patient when speaking to them
- body language - open and empathetic, potentially touch on shoulder etc.
- pace and tone of voice - slow down speaking to give time to think and respond to patient
When might we have a ‘three way’ consultation? What do we need to look out for in these consultations?
- Parent and dependent child
- child and elderly parent
- partners
- family translator
- carer and disabled patient
Look out for
- confidentiality
- monopolisation or abuse
What is Gillick competence and Fraser guidelines?
Medical law that decides whether or not a child under 16 can consent to treatment without consent from a parent: The law says that as long as the child (<16) is intelligent and competent, knowing consequences and knowledge on what’s happening, the parent does not need to consent or be informed.
Fraser guidelines related to sexual health and contraception
- young person understands the advice given
- young person cant be convinced to tell their parents
- young person is likely to begin or continue sexual activity
- unless the person receives contraceptive treatment, their physical (STIs, pregnancy) or mental health (or both) are likely to suffer
- it is in their best interest
Things to do when consulting a young patient with a parent present.
- Ideas concerns and expectations are different between parent and child.
- Making sure the child is comfortable with the parent being there - Gillick
- We need to make sure we are getting an accurate representation - safeguarding issues.
- Parent anxiety
- Engaging child - its their consultation
- Confidentiality of the child - asking if they prefer to be consulted alone without parent around
Things to do when consulting a young patient with a partner present.
- Safeguarding - domestic violence
- Confidentiality
- Engaging patient - its their consultation
- Managing all parties ICE
- Watch for ‘dominant other’ as we may never establish the true issue
Things to look our for with family translators
- confidentiality is broken when a family member is translating. We need to watch body language of the pt. and request a formal translator.
- are you getting the true story
- whose history is it?
- confidentiality cannot be maintained
- safeguarding risks
Times you might use a telephone consultation?
- covid
- more convenient for those who work and are unable to come into the surgery during times open
- house bound
- keeping relatives updated with the patients consent
- out of hours triage
Issues with telephone consultations?
- no verbal cues
- only history available
- can’t examine
- risk management is harder
Managing angry patients
- Being ill can make someone angry
- It’s not you who is angry
- Explore the anger
- Apologise - not an admission of guilt but apologising for long waiting times for example
- Don’t accept aggression in the workplace
