SAQ Test Review - Empathy, Challenging Patient, Breaking Bad News

Question 1

Briefly discuss 5 physician factors that can contribute to making and interview challenging.

Answer 1

Attitude - expressing emotional burnout, insecurity, intolerance for diagnostic uncertainty and negative bias towards a specific health condition all contribute to having an attitude.

Condition - physician often experience exhaustion, anxiety, depressed, personal health issues, sleep deprivation and situational stressors

Knowledge - involves lack of training in physcosocial medicine and lack of knowledge on patient health condition

Skills - the inability to display empathy, easily frustrated and poor communication skills plays a role.

Perceived time pressure- involves seeing a large volume of patients in a short period of time of time which affects the overall quality of consultations and patient interactions

Question 2

What are key recommendation for practice when dealing with challenging patients?

Answer 2

1. Set boundaries and modify scheudule. Helps improving ability to manage difficult encounters.
2. Be mindful of your own inner feelings. This avoids you from labeling a patient as challenging and helps better management of difficult encounters.
3. Display empathy listening skills and non judgmental attitude in patient interactions. This improves patient trust in you and better adherence to treatment
4. Assess challenge patient for underlying physiological illness and know the symptoms associated with it.
5. Assess patients with symptoms of functional somatic disorders.
6. Use patient centered approach with interviewing. Improve therapeutic alliance between patient and doctor and influences behavior change.

Question 3

What are the patient factors that can lead to difficult clinical encounters?

Answer 3

Behavioral issues
Conditions
Psychiatric diagnoses.

Question 4

Describe each patient factor that lead to difficult clinical encounters.

Answer 4

Behavoural issues -
Pt expresses anger, entitlement, manipulative, highly anxious, non adherence to treatment for chronic medical illness and refuse to take responsibility for personal health.

2. Conditions - addiction to drugs and alcohol, chronic pain syndrome, conflict w/ Dr and pt. Goals for the visit and financial constraints causing difficulty with therapy adherence.

Psychiatric diagnoses - dependent personality disorder, disorder where a person is unable to be alone. Depend on person for reassurance and comfort. Often feel anxious when alone and

generalized anxiety disorder- excessive anxiety and worrying. Unable to control the worry. Excessive anxiety and worry can cause significant distress or impairment in social and occupational functioning.

Question 5

Discuss how system factors or issues can contribute to making and interview challenging.

Answer 5

A) Limited resources - inadequate medical supplies and equipment can result in a delay and affect examinations and treatments, also affecting the effectiveness of the interview.

B) Finances - lack of funds can result in limited access to necessary diagnostic tools, specialist referrals or additional support staff, impacting the quality of patient care and communication.

C) Support - lack of support staff can increase the stress and burdens on physicians causing a dent in the time and attention they can dedicate to each patient

D) Time pressure - high patient volumes and strict scheduling can force physicians to rush between consultations resulting in less effective consultations and time spent with the patient.

E) Interruptions - frequent interruptions can disrupt the flow of interviews and prevent physicians from maintaining a focused and comprehensive dialogue with patient.

Question 6

What strategies would you employ to handle challenging patients/ interactions?

Answer 6

1. Active listening
2. Validate the emotions and empathize with the patient
3. Explore alternative solutions
4. Provide closure
5. Remain calm
6. Seek assistance when needed.

Question 7

Discuss the strategies would you employ to handle challenging patients/ interactions?

Answer 7

1. Active listening- understand the patient perspective, allow them to speak with no interruptions. ‘Explains to me the issues that are important to you right now. Let me know how this issue upsets you so much
2. Validate patient emotions and empathize with the patient - recognize and name the emotion the patient is feeling. “I can see why you are upset, you are correct, it’s bad you have been waiting so long with no information.”
3. Explore alternative solutions - engage patient to find different ways to handle the situation differently in the future. ‘What else can i do to assist you in this visit?
4. Provide closure - mutual agreement on a plan for future visits to avoid future difficulties. ‘ i prefer to give certain information in person. Would you like a morning appt. so you can be the 1st person of the day?
5. Remain calm - listen what what the patient has to day. Keep your tone and attitude to a professional approach.
6. Seek assistance if needed. - call for help and leave the room and call for security if you feel like the situation has escalated.

Question 8

What steps can you take to make the interview less challenging before you start seeing the patient?

Answer 8

Prepare the environment
Gather information
Plan your approach
Brief the office staff.

Question 9

Define empathy

Answer 9

The action of understanding, be aware of, be sensitive to and experience the thoughts, feelings and experience of another.. without having the thoughts, feelings and experience fully communicated in an objectively explicit manner.

Question 10

List the 4 types of empathy.

Answer 10

Cognitive
Affective/ Emotional
Behavioral
Moral empathy

Question 11

Describe the 4 types of empathy.

Answer 11

1. Cognitive- the ability to recognize the feelings and emotions of others
2. Affective/ Emotional - to ability to experience the feelings of another.
3. Behavioral - demonstrates behavior that acknowledges the state of emotion of another and that you understand how the person is feeling or going through
4. Moral - to have moral obligation and responsibility to act in accordance with one’s state of emotions regardless of personal feelings.

Question 12

State the reasons for erosion of empathy in healthcare training.

Answer 12

1. Over response to authority - places in a strong hierarchical system in which you take orders,
2. Dehumanization - the denial of distinctively human mind to another person
3. Deindividualization - when we are placed or classified as groups
4. Mechanization
5. Moral disengagement
6. Impaired agency
7. Dissimilarity

Question 13

Define ‘bad news’

Answer 13

Any Information that seriously and adversely affects an individual’s view of his or her future

Question 14

List the qualities of a good counsellor.

Answer 14

Communication skills
Acceptance
Problem solving skills
Self - awareness
Flexible
Rapport building skills
Empathy
Multicultural competency

Question 15

Give examples of health counseling.

Answer 15

Exercise counseling
Counseling patients with chronic diseases
Voluntary counseling and testing in HIV
Smoking cessation

Question 16

Why is breaking bad news important?

Answer 16

Clinical outcomes
A frequent but stressful task
Patient wants the truth
Ethical and legal imperatives

Question 17

State 3 advantages of breaking bad news.

Answer 17

1. Less stress and burnout on doctors
2. Increase confidence in communication unfavorable medical information
3. Patient encouraged to become involved in decision making regarding treatment
4. Less avoidance of discussing stressful information amongst physicians
5. Less misplaced optimism communicated to patients

Question 18

Define Rapport.

Answer 18

The ability to enter another persons model of world, communicating that we truly understand that world.

Question 19

What are the skills needed to ‘invest in the beginning?’

Answer 19

1. Create rapport quickly
2. Elicit the patients concerns
3. Plan the visit with the patient

Question 20

List the techniques used to establish rapport quickly.

Answer 20

• Introduce yourself to everyone in the room
• Address the patient as Ms./Mr. & last name until comfortable with the patient
• Make a social comment or ask a non medical question to ease the patient
• If not the 1st visit, give knowledge of patient history by commenting on previous visit or condition.
• Consider patient cultural background and use appropriate gestures, eye contact and body language.