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Ep. 34: Breaking Bad News
6 Plays2 months ago
Delivering bad news is one of the hardest tasks in healthcare—but with the right approach, it can also be one of the most meaningful. In this episode of Confidence in Conflict, Marcus (former healthcare security director) and Natalie (nurse practitioner and clinical team leader) explore compassionate communication strategies for breaking difficult news while preserving dignity, clarity, and trust. Grounded in Vistelar principles and the SPIKES framework, their discussion offers practical tools that every healthcare professional can use when facing life’s toughest conversations.
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Transcript
Introduction to Podcast and Hosts
00:00:04
Speaker
Good morning, and welcome back to Confidence in Conflict, the podcast for healthcare professionals who want to navigate difficult interactions with greater skill, empathy, and effectiveness.
00:00:13
Speaker
I'm Marcus, your host.
00:00:15
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And I'm Natalie, coming to you from the clinical side of healthcare.
00:00:19
Speaker
Whether you're joining us on your morning commute during a break between shifts or catching up on professional development, we're glad you're here.
Communicating Bad News with Compassion
00:00:28
Speaker
Today we're tackling one of the most challenging aspects of healthcare communication, something every healthcare professional faces but few feel fully prepared for.
00:00:36
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Breaking Bad News, we'll explore compassionate communication techniques that maintain patient dignity while providing essential support during some of life's most difficult moments.
00:00:45
Speaker
This is such a critical topic, Marcus.
00:00:47
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I've been in situations where I've watched colleagues struggle with these conversations, and I've certainly felt that weight myself.
00:00:55
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The emotional toll on both patients and providers is significant, but with the right frameworks and approaches, we can turn these challenging moments into opportunities for connection and healing.
Key Techniques in Healthcare Communication
00:01:07
Speaker
Exactly.
00:01:08
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And what makes this episode particularly valuable is that we're not just talking theory here.
00:01:13
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We're going to ground everything in practical, actionable frameworks, including several Vistalar principles that translate beautifully into these sensitive healthcare conversations.
00:01:22
Speaker
Before we dive deep, let's set some context.
00:01:25
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When we talk about breaking bad news, we're referring to any medical information that significantly alters a patient's view of their health or future.
00:01:34
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This could be a new diagnosis, a poor prognosis, the failure of a treatment, or even unexpected complications.
00:01:41
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And it's worth noting that what constitutes bad news is highly subjective.
00:01:46
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What might seem routine to a seasoned healthcare professional can be earth-shattering to a patient and their family.
00:01:52
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The key is approaching every potentially difficult conversation with the same level of preparation and empathy.
Foundations of Respectful Medical Conversations
00:01:58
Speaker
Absolutely.
00:02:00
Speaker
So, Marcus, let's start with the foundation.
00:02:04
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What are the core principles that should guide any difficult medical conversation?
00:02:09
Speaker
Great question, Natalie.
00:02:11
Speaker
I think it starts with something we talk about frequently in our Vistalar training, the universal greeting.
00:02:16
Speaker
This isn't just about starting a conversation.
00:02:18
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It's about establishing a tone of respect, professionalism, and collaboration from the very first moment.
00:02:23
Speaker
That's such a crucial point.
00:02:25
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The universal greeting in healthcare settings means introducing yourself clearly, stating your role, and creating an environment where the patient feels safe and respected.
00:02:36
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For example, hello, Mrs. Johnson.
00:02:39
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I'm Dr. Smith, the oncologist who's been reviewing your test results.
00:02:44
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I'd like to sit down with you and discuss what we found.
00:02:47
Speaker
And notice how that approach immediately signals several things.
00:02:50
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Respect for the patient's identity, clarity about who you are and your role, and a collaborative tone that suggests partnership rather than a one-way delivery of information.
00:03:00
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Exactly.
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It also gives the patient a moment to mentally prepare for what's coming.
00:03:07
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Now, building on that foundation, there's a widely recognized framework in healthcare communication called SPIKES that aligns beautifully with Vistalar's principles.
Preparing for Difficult Conversations
00:03:17
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Should we walk through that?
00:03:19
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Absolutely.
00:03:20
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SPIKES is an acronym that stands for setting, perception, invitation, knowledge, empathy, and summarize.
00:03:26
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Let's break each of these down with practical examples.
00:03:29
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The S in SPIKES stands for setting, and this is where we prepare the physical and emotional environment for the conversation.
00:03:37
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This means finding a private space, ensuring we won't be interrupted, having tissues available, and making sure the patient is comfortable.
00:03:45
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This connects directly to what we teach about environmental awareness and conflict management.
00:03:50
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The setting communicates respect and signals the importance of the conversation.
00:03:54
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A rushed conversation in a busy hallway sends a very different message than a thoughtful discussion in a quiet room where the patient can process emotions privately.
00:04:02
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The second element, perception, involves assessing what the patient already knows or suspects about their condition.
00:04:09
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We might ask questions like, what is your understanding of why we ran these tests?
00:04:15
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Or, what have other doctors told you about your condition?
00:04:19
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This is similar to what we call mining for information in our VISTOLAR training.
00:04:23
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We're gathering intelligence about the patient's current emotional and mental state so we can tailor our communication appropriately.
00:04:30
Speaker
A patient who's been expecting bad news will receive information differently than someone who's been optimistic about their results.
Understanding Patient Information Needs
00:04:36
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The I stands for invitation, where we ask the patient how much information they want to receive.
00:04:42
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Some patients want every detail, while others prefer a high-level overview.
00:04:47
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We might ask, would you like me to give you all the specific details, or would you prefer I focus on what this means for your care moving forward?
00:04:56
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This is about respecting patient autonomy, a core principle in both healthcare and conflict management.
00:05:02
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We're acknowledging that the patient has a right to control how much information they receive and when.
Clear Communication Without Jargon
00:05:07
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Now we get to the K-knowledge, where we actually deliver the medical information.
00:05:12
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This is where many healthcare providers feel the most pressure, but having a structured approach really helps.
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We want to use clear, simple language, avoid medical jargon, and deliver information in small, digestible pieces.
00:05:26
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And this is where some key Vistalar communication principles become essential.
00:05:30
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We talk about adapting our communication style to meet people where they are.
00:05:34
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If someone is in shock or experiencing high stress, we need to slow down, use shorter sentences, and pause frequently to allow for processing time.
00:05:43
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Exactly.
00:05:44
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I remember learning that interactions often fail because we stand too close, talk too loudly, talk too fast, say too much, and touch too soon.
00:05:54
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When delivering difficult news, we need to be especially mindful of these factors.
Empathy in Medical Communication
00:05:59
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The E in spikes represents empathy, and this is where the conversation becomes deeply human.
00:06:04
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Empathy isn't just about saying, I'm sorry, though appropriate apologies have their place.
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It's about recognizing and validating the patient's emotional response.
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This is where beyond active listening becomes so valuable.
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We're not just hearing the words.
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We're observing body language, tone of voice, and emotional cues.
00:06:22
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We might reflect what we're seeing.
00:06:24
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I can see this news is overwhelming or you look shocked, which is completely understandable.
00:06:31
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And empathy in health care settings often means acknowledging the legitimacy of the patient's feelings without trying to fix them immediately.
00:06:37
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Sometimes the most powerful thing we can say is, this is really hard news and it's okay to feel scared or angry about it.
00:06:44
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The final S stands for summarize and strategize.
00:06:49
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This is where we recap the key information, discuss next steps, and help the patient begin to see a path forward.
00:06:56
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We're not leaving them in despair.
00:06:58
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We're providing hope and concrete plans for moving ahead.
00:07:02
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This connects to what we call closure skills in VISTLR training.
00:07:06
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We're ending the conversation in a way that leaves the patient feeling supported and clear about what happens next, even when the news itself is difficult.
Managing Conversations and Environment
00:07:13
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Marcus, let's talk about some specific techniques for each of these phases, starting with the setting.
00:07:20
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What are some practical considerations that health care providers might overlook?
00:07:25
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One big one is managing interruptions.
00:07:27
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I've seen well-intentioned conversations derailed by phone calls, pages, or staff members needing urgent answers.
00:07:33
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When we're having these crucial conversations, we need to create a protected space where the patient feels like they have our complete attention.
00:07:39
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and seating arrangements matter more than people realize.
00:07:43
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Sitting at the same level as the patient, rather than standing over them, communicates respect and partnership.
00:07:50
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If the patient is in bed, pulling up a chair so you're at eye level makes a significant difference in how the conversation feels.
00:07:58
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Body language is huge here.
00:07:59
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Our posture, facial expressions, and hand positioning all send messages.
00:08:04
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Open, relaxed posture with visible hands, similar to the universal greeting stance, helps create an atmosphere of safety and transparency.
00:08:12
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Let's talk about the perception phase.
00:08:15
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What are some effective ways to assess what a patient already knows without making them feel like we're testing them?
00:08:21
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I like approaches that feel conversational rather than interrogative.
00:08:25
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Instead of, what do you know about your condition?
00:08:28
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We might say, help me understand what other doctors have shared with you about your symptoms, or tell me about your experience with this illness so far.
00:08:35
Speaker
And we need to listen not just for medical facts, but for emotional undertones.
00:08:41
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A patient might say, the ER doctor said my tests were abnormal and I needed to follow up.
00:08:47
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But their tone might convey anxiety, confusion, or denial.
00:08:51
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That emotional intelligence guides how we proceed.
Patient Autonomy in Information Sharing
00:08:55
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When it comes to the invitation phase, it's important to recognize that some patients may not know how to answer the question about how much information they want.
00:09:03
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They might need some guidance about their options.
00:09:05
Speaker
Right.
00:09:06
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We might explain, some people want to know all the medical details and statistics, while others prefer to focus on treatment options and next steps.
00:09:15
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Some people want to hear everything today, while others need to process information gradually.
00:09:21
Speaker
What feels right for you?
00:09:24
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And we need to respect if someone says they're not ready for detailed information.
00:09:27
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That doesn't mean we avoid difficult conversations entirely, but we might adjust our approach to focus on immediate care needs while preparing them for future discussions.
00:09:36
Speaker
Now, when we get to actually delivering the knowledge, the medical information, this is where clear communication becomes absolutely critical.
00:09:45
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Marcus, what are some common pitfalls health care providers fall into here?
00:09:51
Speaker
One major issue is information overload.
00:09:53
Speaker
When we're nervous or uncomfortable, we sometimes default to giving too much information too quickly, thinking that more details will somehow make the news easier to process.
00:10:02
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But the opposite is usually true.
00:10:04
Speaker
Exactly.
00:10:05
Speaker
I've learned to deliver difficult news in what I call headline and details format.
00:10:10
Speaker
I start with the main message, the scan showed that the cancer has spread to your liver, and then pause to let that sink in before offering additional details.
Allowing Time for Information Processing
00:10:20
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The pause is so important.
00:10:22
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We need to fight our instinct to fill silence with more talking.
00:10:25
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After delivering significant news, people need processing time.
00:10:29
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They might need to cry, ask questions, or just sit with the information.
00:10:32
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And we need to watch for signs that the patient has stopped processing new information.
00:10:38
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If someone is staring blankly, crying, or asking us to repeat things we just said, it's time to slow down or pause the medical information and focus on emotional support.
00:10:49
Speaker
Let's talk about language choices.
00:10:51
Speaker
Medical jargon isn't just confusing.
00:10:53
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It can feel exclusionary and cold during an already difficult conversation.
Using Everyday Language Effectively
00:10:58
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How do we balance accuracy with accessibility?
00:11:00
Speaker
I try to use everyday language first, then provide the medical terms if needed.
00:11:05
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Instead of saying, you have a myocardial infarction, I might say, you've had a heart attack, which doctors call a myocardial infarction.
00:11:15
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This way the patient understands the concept and learns the terminology they'll hear other providers use.
00:11:21
Speaker
And metaphors can be powerful tools for explaining complex medical concepts.
00:11:25
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Comparing the heart to a pump or cancer to weeds in a garden helps patients understand their condition in relatable terms.
Specific vs. Generic Acknowledgments
00:11:32
Speaker
Now let's dive deeper into the empathy component, because this is where many health care providers feel uncertain.
00:11:40
Speaker
How do we express empathy authentically without sounding scripted or insincere?
00:11:46
Speaker
This ties back to our Beyond Active Listening training.
00:11:49
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Authentic empathy starts with genuinely observing and acknowledging what we're witnessing.
00:11:54
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If someone is crying, we acknowledge the tears.
00:11:57
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If they seem angry, we recognize the anger without taking it personally.
00:12:01
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And empathetic responses often work best when they're specific rather than generic.
00:12:06
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Instead of just saying, I know this is hard, we might say, I can see you're worried about how this will affect your ability to care for your grandchildren.
00:12:15
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Or, you look shocked, which makes complete sense given how sudden this news is.
00:12:21
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Empathy also means validating emotional responses that might seem inappropriate or unexpected to us.
00:12:27
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Some people laugh when they receive bad news, others get angry at health care providers, and some become very quiet.
00:12:33
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All of these are normal responses to a crisis.
00:12:36
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And we need to be comfortable with emotional expression.
00:12:39
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If someone needs to cry, we don't rush to comfort them or change the subject.
00:12:43
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We might simply say, take all the time you need and sit quietly with them in their emotion.
00:12:49
Speaker
What about when families are involved?
00:12:51
Speaker
The dynamics become more complex when we're delivering bad news to multiple people who may have different emotional responses and information needs.
00:12:58
Speaker
That's such a great point.
00:13:00
Speaker
Family meetings require additional skills in group dynamics and conflict management.
00:13:05
Speaker
We need to establish ground rules about who speaks for the patient, how decisions will be made, and how to handle disagreements that might arise.
00:13:14
Speaker
and we often see family members trying to protect each other from difficult information.
00:13:18
Speaker
A spouse might say, don't tell him how serious this is.
00:13:21
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It'll crush him.
00:13:23
Speaker
These situations require gentle but firm boundary setting about the patient's right to information about their own health.
Validating Patient Experiences
00:13:29
Speaker
The Vistalar principle of empathy without agreement becomes really relevant here.
00:13:34
Speaker
We can empathize with the family's desire to protect their loved one while maintaining our professional obligation to provide accurate information to the patient.
00:13:45
Speaker
Let's talk about some specific phrases and approaches that work well in these conversations.
00:13:49
Speaker
Natalie, what are some empathetic responses you found effective?
00:13:53
Speaker
I've learned that simple acknowledgements are often more powerful than complex explanations.
00:13:59
Speaker
Phrases like, this wasn't the news you were hoping for, I can see this is overwhelming, or this is really scary news.
00:14:07
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Validate the patient's experience without minimizing it.
00:14:11
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And it's important to avoid phrases that might sound dismissive, even when they're meant to be comforting.
00:14:16
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Saying things like, don't worry, or everything happens for a reason, or at least it's treatable, can minimize the patient's legitimate emotional response.
00:14:24
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Another powerful technique is reflecting both the content and the emotion we're observing.
00:14:29
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You're telling me you understand the diagnosis, but you look like you're still processing how this changes your life.
00:14:37
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This shows we're paying attention to the whole person, not just their verbal responses.
00:14:43
Speaker
What about handling our own emotions during these conversations?
00:14:46
Speaker
Health care providers are human too, and delivering bad news repeatedly can take an emotional toll.
00:14:52
Speaker
This is so important, Marcus.
00:14:54
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I think many providers feel like they need to be completely stoic during these conversations.
00:14:59
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But appropriate emotional expression can actually be therapeutic for patients.
00:15:04
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If we're genuinely sad about someone's diagnosis, it's okay to say, this is really sad news and I'm sorry you're facing this.
00:15:12
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The key is making sure our emotions don't overwhelm the patient's emotions or redirect the focus away from their experience.
Ongoing Support and Next Steps
00:15:18
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Our emotions should validate theirs, not compete with them.
00:15:21
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And we need to recognize when we're carrying too much emotional weight from these conversations.
00:15:27
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Regular debriefing with colleagues, seeking supervision when needed, and maintaining our own emotional health are professional responsibilities, not luxuries.
00:15:38
Speaker
Let's talk about the summary and strategize phase.
00:15:41
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This is where we help patients move from receiving difficult information to understanding their options and next steps.
00:15:48
Speaker
This phase is crucial because it's where we transform what could be a hopeless conversation into an empowering one.
00:15:55
Speaker
Even when the medical news is very serious, there are almost always meaningful choices and actions the patient can take.
00:16:03
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We might summarize by saying something like, let me make sure I've explained this clearly.
00:16:08
Speaker
The scan shows that your cancer has spread, which means the surgery we discussed won't be the best option for you.
00:16:13
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However, we have several treatment approaches that can help manage your symptoms and potentially slow the cancer's progress.
00:16:20
Speaker
And then we immediately follow with concrete next steps.
00:16:24
Speaker
I'd like to schedule you to meet with our oncologist this week to discuss treatment options.
00:16:29
Speaker
And I'll have our social worker connect with you about support resources for you and your family.
00:16:35
Speaker
This approach gives patients a sense of agency and control during a time when they may feel powerless.
00:16:40
Speaker
We're showing them that while we can't change the diagnosis, we can certainly influence how they experience and respond to it.
00:16:46
Speaker
What about follow-up?
00:16:48
Speaker
These conversations don't end when we leave the room.
00:16:51
Speaker
How do we ensure ongoing support and communication?
00:16:54
Speaker
Follow-up is essential because people often think of questions or experience different emotions hours or days after receiving difficult news.
00:17:02
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We should always provide clear information about how patients can reach us or other members of their care team.
00:17:07
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And we need to check in proactively, not just wait for patients to contact us.
00:17:12
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A phone call the next day to ask how they're doing and whether they have questions, shows we're invested in their well-being beyond just the medical facts.
00:17:22
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I also think it's important to involve other members of the care team, social workers, chaplains, patient navigators, who can provide different types of support than what we as clinical providers can offer.
Applying Communication Principles in Practice
00:17:32
Speaker
Let's talk about some specific scenarios where these principles apply.
00:17:37
Speaker
Marcus, can you walk us through how this might look in an emergency department setting?
00:17:42
Speaker
Great example.
00:17:43
Speaker
Emergency departments present unique challenges for difficult conversations, noise, time pressure, multiple patients, and often no prior relationship with the patient.
00:17:53
Speaker
But the principles still apply.
00:17:55
Speaker
The setting becomes even more critical in the ED.
00:17:59
Speaker
We might need to work harder to find a quiet space or at least minimize distractions.
00:18:05
Speaker
And the universal greeting becomes essential because the patient may never have seen us before.
00:18:10
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We might say, hello, mister.
00:18:13
Speaker
Rodriguez, I'm Dr. Thompson, the emergency physician who's been taking care of you tonight.
00:18:18
Speaker
I've been reviewing your test results, and I need to discuss some concerning findings with you.
00:18:23
Speaker
Is your wife here?
00:18:24
Speaker
Would you like her present for this conversation?
00:18:27
Speaker
And in the ED, the perception phase might reveal that patients have been hoping for reassurance.
00:18:33
Speaker
They came in expecting to be told everything was fine and sent home.
00:18:37
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That changes how we deliver news about a serious diagnosis or the need for admission.
00:18:42
Speaker
Time constraints in the ED also mean we need to be more focused in our communication.
00:18:47
Speaker
We can't have a lengthy conversation about every detail, but we can still deliver news compassionately and ensure the patient feels heard and supported.
00:18:55
Speaker
What about in oncology settings, where difficult conversations are unfortunately routine?
00:19:01
Speaker
How do these principles apply when we're discussing treatment failures or progression?
00:19:07
Speaker
Oncology presents the challenge of ongoing relationships where we're delivering multiple pieces of difficult news over time.
00:19:13
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The SPIKES framework becomes a familiar routine that provides consistency and structure for both providers and patients.
00:19:19
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And in oncology, we often see patients and families who have become very knowledgeable about their condition.
Handling Denial and Sophisticated Understanding
00:19:26
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The perception phase might reveal sophisticated understanding of medical concepts, which allows us to have more detailed conversations,
00:19:35
Speaker
But we also see a lot of denial and magical thinking in cancer care.
00:19:39
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Patients who understand the medical facts but can't emotionally accept them.
00:19:43
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The empathy phase becomes crucial for acknowledging this disconnect without arguing with their coping mechanisms.
00:19:49
Speaker
Let's talk about pediatric considerations.
00:19:51
Speaker
When we're delivering bad news about a child's condition, we're usually talking to parents while also considering the child's developmental needs.
00:20:00
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Pediatric conversations often involve multiple relationships.
00:20:04
Speaker
The medical relationship with the child, the consultative relationship with the parents, and the family system dynamics.
00:20:10
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We need to consider what's appropriate for the child to hear while respecting the parent's role as decision makers.
00:20:16
Speaker
And children often pick up on emotional cues, even when we think we're protecting them from information.
00:20:22
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A seven-year-old might not understand the medical details of their diagnosis, but they absolutely understand when their parents are scared and sad.
00:20:32
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Age-appropriate communication becomes crucial.
00:20:34
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We might tell a young child, your body is sick and we need to give you medicine to help you feel better, while having a more detailed conversation with teenagers about their diagnosis and treatment options.
00:20:45
Speaker
What about cultural considerations?
00:20:47
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Different cultures have very different approaches to medical information and family involvement in healthcare decisions.
Cultural Approaches to Medical Decision-Making
00:20:54
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This is where cultural competence becomes essential.
00:20:57
Speaker
Some cultures prioritize family decision-making over individual autonomy.
00:21:02
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Others have strong beliefs about the power of words to influence health outcomes.
00:21:06
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We need to assess cultural preferences early in the relationship.
00:21:10
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We might ask, in your family, how are important medical decisions typically made?
00:21:16
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Or, who would you like involved in conversations about your care?
00:21:20
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And we need to avoid making assumptions based on appearance or names.
00:21:24
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Cultural identity is complex, and people may have different preferences than what we might expect based on their background.
00:21:30
Speaker
Let's address some of the emotional challenges healthcare providers face with these conversations.
00:21:36
Speaker
Marcus, what are some common fears or concerns that might make providers hesitant to have difficult conversations?
Healthcare Providers' Fears of Difficult Conversations
00:21:45
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One big fear is feeling responsible for the patient's emotional reaction.
00:21:48
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Providers sometimes avoid difficult conversations because they're afraid of making the patient cry or become upset.
00:21:55
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But we need to remember that we're not causing their distress.
00:21:57
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We're providing information they need to make informed decisions about their care.
00:22:01
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Another common fear is not having all the answers to the questions patients might ask.
00:22:07
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But it's perfectly acceptable, and often preferable, to say, that's a really important question that I don't have the answer to right now.
00:22:15
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Let me find out and get back to you.
00:22:18
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And some providers worry about taking away hope, but hope and honesty aren't mutually exclusive.
Addressing Patient Anger
00:22:23
Speaker
We can be honest about serious diagnoses while helping patients find realistic reasons for hope, whether that's symptom management, quality time with family, or contributing to research that might help others.
00:22:34
Speaker
What about when patients or families become angry during these conversations?
00:22:39
Speaker
That can be intimidating for healthcare providers who aren't used to managing conflict.
00:22:44
Speaker
This is where our VISTLR training in conflict management becomes directly applicable to health care.
00:22:49
Speaker
Anger is often a secondary emotion covering fear, sadness, or feeling powerless.
00:22:54
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When someone becomes angry during a medical conversation, they're usually not angry at us personally.
00:22:59
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They're angry at the situation.
00:23:01
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We can acknowledge their anger without taking it personally.
00:23:05
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I can see you're really angry about this diagnosis.
00:23:08
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That's completely understandable.
00:23:10
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This isn't what you expected to hear today.
00:23:13
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And sometimes we need to set gentle boundaries if anger becomes disruptive or threatening.
00:23:17
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I understand you're upset, and I want to continue helping you.
00:23:21
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I need us to keep our voices calm so we can focus on your care.
00:23:24
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What about denial?
00:23:26
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How do we handle patients who refuse to accept medical information or who insist on unrealistic expectations?
Gently Handling Denial
00:23:33
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Denial is actually a normal and often adaptive response to overwhelming news.
00:23:38
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Fighting denial directly usually backfires.
00:23:41
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Instead, we can acknowledge it while gently introducing reality.
00:23:45
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I hear you saying you don't believe this diagnosis.
00:23:48
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That's not unusual.
00:23:49
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This is shocking news.
00:23:51
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Tell me what you're thinking about this.
00:23:53
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and we need to distinguish between temporary denial, which is a normal part of processing difficult information, and persistent denial that interferes with medical decision-making.
00:24:04
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Temporary denial often resolves with time and support.
00:24:08
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Sometimes we can work around denial by focusing on symptoms rather than diagnoses.
00:24:13
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Regardless of what we call this condition, you're experiencing pain and difficulty breathing.
00:24:18
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Let's talk about how we can help you feel more comfortable.
00:24:21
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Let's talk about some advanced techniques for particularly challenging situations.
00:24:26
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What about when we need to deliver news that a treatment has failed or that we're transitioning to comfort care?
Transitioning to Comfort Care
00:24:33
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These conversations require extra sensitivity because they often involve shifting goals and expectations.
00:24:39
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We might start with, when we began this treatment, we were hoping it would shrink your tumors.
00:24:44
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The scans show that hasn't happened.
00:24:46
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I'd like to talk about what this means and discuss our options moving forward.
00:24:50
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And it's crucial to help patients and families understand that changing treatment goals doesn't mean giving up.
00:24:57
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Comfort care is still active.
00:24:59
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Important medical care.
00:25:01
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It's just focused on different outcomes.
00:25:03
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We might say, we're not giving up on you.
00:25:06
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We're changing our focus from trying to cure your cancer to making sure you're as comfortable as possible and that you can spend quality time with the people you love.
00:25:14
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What about sudden unexpected deaths, like when we need to tell a family that their loved one didn't survive surgery or died unexpectedly in the hospital?
Communicating Unexpected Deaths Compassionately
00:25:23
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These are among the most difficult conversations we have because there's no time for preparation or gradual disclosure.
00:25:30
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The key is to be direct while also being compassionate.
00:25:33
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I have very difficult news to share with you.
00:25:35
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Despite everything we did, your husband's heart stopped during surgery and we weren't able to bring him back.
00:25:41
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In these situations, we often see immediate shock and disbelief.
00:25:45
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People may ask us to repeat the information multiple times or ask questions that suggest they haven't fully processed what we've told them.
00:25:53
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That's completely normal.
00:25:55
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And we need to be prepared for intense emotional reactions, screaming, collapsing, anger directed at us.
00:26:01
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These aren't personal attacks.
00:26:02
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They're expressions of overwhelming grief and shock.
00:26:06
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Let's talk about some practical tools and resources that healthcare providers can use to improve their skills in these conversations.
00:26:14
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Training and practice are essential.
00:26:16
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Many healthcare systems now provide communication skills, training that includes role-playing difficult conversations.
00:26:22
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These workshops help providers practice techniques in a safe environment before using them with actual patients.
00:26:28
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Simulation training can be particularly valuable because it allows providers to experience the emotional intensity of these conversations without the real-world consequences.
00:26:39
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We can make mistakes, get feedback, and try different approaches.
00:26:44
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Mentorship is also crucial.
00:26:46
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Newer providers should have opportunities to observe experienced colleagues having these conversations and then be supported as they develop their own skills.
Resources for Ongoing Support
00:26:54
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And debriefing after difficult conversations, both immediately and over time, helps providers process their own emotions and identify areas for improvement.
00:27:05
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What about resources for patients and families?
00:27:07
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We shouldn't expect one conversation to meet all their needs for information and support.
00:27:12
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Written materials that summarize key information can be incredibly valuable because patients often can't remember everything discussed during emotionally intense conversations.
00:27:24
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These might include diagnosis explanations, treatment options, or contact information for support services.
00:27:31
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Support groups, whether in person or online, connect patients with others facing similar challenges.
00:27:37
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Peer support can provide perspectives and encouragement that health care providers can't offer.
00:27:42
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and professional counseling services.
00:27:44
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Social workers, psychologists, chaplains provide specialized support for processing emotions and making decisions during health crises.
Virtual Healthcare Communication
00:27:54
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Let's talk about technology and how it's changing these conversations.
00:27:57
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Telemedicine has become much more common, especially since the pandemic.
00:28:01
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How do we adapt these principles to virtual conversations?
00:28:04
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Virtual conversations present unique challenges for delivering difficult news.
00:28:10
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We lose some of our ability to provide physical comfort and may miss subtle nonverbal cues.
00:28:16
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But many of the same principles apply.
00:28:19
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The setting becomes even more important in virtual visits.
00:28:22
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We need to ensure privacy on both ends, minimize technical difficulties, and create as warm and supportive an environment as possible through the screen.
00:28:30
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And we might need to be more explicit about what we're observing.
00:28:33
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I can see this news is hard for you to hear.
00:28:36
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Or you look like you might have questions about this.
00:28:40
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Follow-up becomes crucial with virtual visits because we have less information about how the patient is coping after the conversation ends.
00:28:47
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We might schedule more frequent check-ins or provide additional ways for patients to reach us.
00:28:52
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What about documentation?
00:28:53
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How do we appropriately record these sensitive conversations in the medical record?
Documenting Patient Understanding
00:28:58
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Documentation should capture the key information discussed, the patient's understanding and emotional response, who was present, and the plan moving forward.
00:29:06
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This helps ensure continuity of care and protects both the patient and provider.
00:29:10
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But we need to be thoughtful about how we document emotional responses.
00:29:15
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Writing patient became hysterical is less helpful than patient expressed sadness and concern about the impact of this diagnosis on her ability to care for her children.
00:29:29
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And documentation should reflect the compassionate, respectful approach we took during the conversation.
00:29:34
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Future providers reading the record should understand how the news was delivered and what support was provided.
00:29:39
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Let's talk about measuring the effectiveness of these conversations.
00:29:43
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How do we know if we're doing this well?
Assessing Communication Success
00:29:46
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Patient feedback is crucial, though it often comes indirectly.
00:29:50
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Comments like, the doctor really listened to me, or I felt like she cared about me as a person, suggest that our communication was effective.
00:29:58
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Follow-up conversations also provide insight.
00:30:01
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If patients ask the same questions repeatedly or seem confused about information we thought we explained clearly, that suggests we need to adjust our communication approach.
00:30:11
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And our own emotional response can be informative.
00:30:14
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If we consistently feel drained, frustrated, or upset after these conversations, that might indicate we need additional training or support.
00:30:22
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What about prevention?
00:30:24
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Are there ways we can prepare patients and families for potentially difficult news before we have specific information to share?
Setting Expectations for Test Results
00:30:32
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Absolutely.
00:30:33
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When we order tests or consultations that might reveal serious conditions, we can prepare people for the possibility of concerning results.
00:30:40
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We're running these tests to rule out some serious conditions.
00:30:43
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Most of the time, the results are reassuring, but I want to prepare you that we might find something that requires treatment.
00:30:50
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This approach helps prevent the shock and disbelief that can make it harder for people to process medical information.
00:30:57
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It also demonstrates our commitment to honesty and transparency from the beginning of the relationship.
00:31:03
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And we can establish our communication preferences early.
00:31:07
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I believe in being honest and direct with patients about their health.
00:31:10
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If we find something concerning, I'll schedule time to sit down with you and discuss it thoroughly.
00:31:14
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Is that approach comfortable for you?
00:31:17
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As we start to wrap up our discussion, let's talk about the broader impact of compassionate communication in health care.
00:31:24
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Marcus, how do these skills affect the overall health care experience?
Impact of Effective Communication
00:31:28
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When health care providers excel at difficult conversations, it transforms not just individual interactions but entire organizational cultures.
00:31:37
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Patients feel more respected and supported.
00:31:39
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Families have greater trust in the healthcare system, and providers find more meaning and satisfaction in their work.
00:31:45
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And these skills have ripple effects beyond the specific conversation.
00:31:50
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Patients who feel heard and supported during difficult moments are more likely to follow treatment recommendations, maintain relationships with their healthcare providers, and have better overall health outcomes.
00:32:03
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From a conflict management perspective, compassionate communication prevents many of the disputes and complaints that arise when patients feel dismissed or poorly informed.
00:32:11
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It's much easier to prevent conflict through good communication than to resolve it after problems have developed.
00:32:16
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These skills also protect health care providers from emotional burnout.
00:32:21
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When we have effective tools for navigating difficult conversations, we feel more confident and confident in our ability to help patients through crisis moments.
00:32:30
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And there's a professional development aspect too.
00:32:33
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Providers who are skilled in difficult conversations often become resources for their colleagues, helping to elevate the overall quality of communication within their organizations.
Encouraging Reflective Practice for Improvement
00:32:43
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What advice would we give to health care providers who want to improve their skills in this area?
00:32:48
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Where should they start?
00:32:50
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I'd recommend starting with self-reflection about your current approach to difficult conversations.
00:32:55
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What feels challenging?
00:32:56
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What are you avoiding?
00:32:58
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What would you like to do differently?
00:33:00
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and seek out training opportunities.
00:33:02
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Many healthcare organizations offer communication skills workshops, and there are excellent online resources and books available.
00:33:10
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The investment in learning these skills pays dividends throughout your entire career.
00:33:15
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Practice is essential, but practice thoughtfully.
00:33:19
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Don't just repeat the same approaches that aren't working, try new techniques, ask for feedback from colleagues, and reflect on what you learned from each conversation.
00:33:27
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And remember that becoming skilled at these conversations is a career-long process.
00:33:33
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Even experienced providers continue learning and refining their approach based on new situations and patient feedback.
00:33:41
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Finally, take care of yourself emotionally.
00:33:44
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These conversations are emotionally demanding, and providers need support systems and coping strategies to maintain their ability to be present and compassionate with patients.
Summarizing Key Learning Points
00:33:54
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Before we close, let's recap the key takeaways from today's discussion.
00:33:58
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What are the most important points for our listeners to remember?
00:34:02
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First, that breaking bad news is a skill that can be learned and improved through training and practice.
00:34:08
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You don't have to rely on intuition alone.
00:34:10
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There are evidence-based frameworks that provide structure and guidance.
00:34:13
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Second, that empathy and honesty aren't contradictory.
00:34:18
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We can be honest about serious medical conditions while still being compassionate and supportive.
00:34:23
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In fact, honest communication delivered compassionately is often the most healing approach.
00:34:30
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Third, that these conversations are about much more than just sharing medical information.
00:34:35
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They're opportunities to demonstrate respect for patient dignity, provide emotional support, and strengthen therapeutic relationships.
00:34:41
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Fourth, that preparation and setting matter tremendously.
00:34:46
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Taking time to create the right environment and approach these conversations thoughtfully makes a significant difference in their effectiveness.
00:34:54
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And finally, that these skills benefit everyone involved, patients, families, and healthcare providers.
00:35:01
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Investing in communication skills is investing in the quality of healthcare relationships and outcomes.
Acknowledgment and Encouragement for Providers
00:35:06
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As we wrap up today's episode, I want to acknowledge that if you're a healthcare provider listening to this, you're probably dealing with these challenging conversations regularly.
00:35:17
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The work you do in these moments, providing information, support, and compassion during some of life's most difficult times, is profoundly important.
00:35:26
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We hope today's discussion has provided you with some practical tools and perspectives that you can apply in your own practice.
00:35:32
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Remember that mastering these skills is a journey, not a destination.
00:35:36
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Every conversation is an opportunity to practice compassion and connect with another human being during their time of need.
00:35:43
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The frameworks we've discussed today, from the universal greeting to spikes to beyond active listening, are tools to help you navigate these conversations with greater confidence and effectiveness.
00:35:54
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But ultimately, your genuine care and concern for your patients is the most powerful element in any difficult conversation.
00:36:04
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And if you're not a direct health care provider but work in health care support roles, these principles apply to you too.
00:36:09
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Whether you're in administration, security, or any other health care role, you may find yourself in situations where someone needs compassionate communication and emotional support.
00:36:18
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We'd love to hear about your experiences with these concepts.
00:36:21
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If you try any of the techniques we've discussed today, or if you have your own strategies for navigating difficult conversations, please share them with us.
00:36:31
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These discussions are enriched by the real world experiences of healthcare professionals.
Engaging with the Podcast Community
00:36:36
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If today's episode has been helpful, we'd really appreciate it if you could take a moment to follow the podcast, leave us a rating, and write a review.
00:36:44
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Your feedback helps us reach more healthcare professionals who could benefit from these discussions, and it helps us create episodes that address the topics you care about most.
00:36:52
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You can find us on all major podcast platforms, and we'd love to connect with you on social media as well.
00:36:59
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Share your thoughts, suggest future topics, or just let us know how these concepts are working in your practice.
00:37:07
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Until next week, remember that every difficult conversation is an opportunity to demonstrate the best of what health care can be.
00:37:14
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professional, compassionate, and deeply human.
00:37:17
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Take care of yourselves and the patients you serve.
00:37:20
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Thanks for joining us on Confidence in Conflict.
00:37:23
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We'll see you next Wednesday for another episode focused on helping healthcare professionals navigate challenging interactions with skill and compassion.
00:37:33
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This has been Confidence in Conflict.
00:37:34
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I'm Marcus.
00:37:35
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And I'm Natalie.
00:37:37
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Stay safe out there.
00:37:39
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This podcast uses synthetic voices to share Vistalar's training and communication strategies.