1.6 Komunikasi Pada Kasus Tertentu

8/12/2019 1.6 Komunikasi Pada Kasus Tertentu

1/43

COMMUNICA TION B ETWEENDOCTORS, PA TIENTS & THEIR

FAMILIESBREAKING BAD NEWS

R. Sjamsu hid ajatTjakra Wibaw a Manu aba

Sutr isno Al ibasyahPerioperat ive Cour se.

Col leg iums o f Surgery & Anes thes io logy.Indonesia


2/43

DOCTORS PA TIENTSRELATIONSHIP.

Not an ym o re p aternali smSho u ld b e p ar tnership b as is .

Equal


3/43

Communication is not:as some would say, simply goodmanners, empathy, being nice or

pandering to the patients.

BUT it offers a much more effectiveconsultation, and improved outcomesboth patients and doctors.

HOPEFULLY.NOT The blind leading the blind?


4/43


5/43

ISSUES IN DOCTOR PATIENTCOMMUNICATION


6/43


7/43

Why teach and learn co m m un icat ionski l ls .

Is there evidenc e that com m un icat ionsk i l ls can ov ercom e these p rob lem s andm ake a d i fference to p at ien ts , do cto rs , andou tcom es o f care (pro cess o f in terview ,pat ient s at isfact io n, pat ient r ecall &un ders tand ing , adherenc e, ou t com e)


8/43

Can yo u teach and learn com m un icat ion sk i l l s .

Is th ere ev idence tha t com m unic at ion c an betaugh t and learned.

Is th ere evid ence th at learnin g is retained.

Is th e pr ize on o ffer to d octo rs and p at ien ts w or thth e effor t .

w i l l expand ing the effo r t on com m unica tion sk i l lsteaching , p rod uce wo r thw hi le rew ards fo r bo thdoc tors and pat ien ts .


9/43

The answers are .yes


10/43

Und erly ing Prem ises

- Com m un icat ion sk i l ls t each ing and learn ing

need to b e evidenc e based.

- Uni fied app roach to com m un icat ion sk i l lsteaching in m edic in e i s needed.

- Com m un icat ion sk i l ls t each ing sho u ld c ross

cu l tura l and n ation al bo un dar ies .


11/43

Underlying Premises..

- Coord ina ted app roach to com m unica t ion

ski l l s teaching throu gh out m edica l edu cat ionis necess ary.

- A sk i l l, based on app roach to com m un icat ion

sk i l ls teachin g is ess ent ial .


12/43

HUMA N REA CTION IN FA CINGDISEA SE WITHOUT

ANY HOPE. Patients , Fam ilies, &Health pr ofess ion als .


13/43

In Critically ill patients :We have to deal with stressful depressed

patient, and the families.

We have to deal with other colleaguesother doctors, nurses who sometimesare also depressed

in a very tense and depressingsituation or atmosphere!


14/43

How hu m an being faces c r i t ica l/ severediseases?

Emo t ional Changes .

Negat ive Emo t ional Chang es ( no m ore

h op e, ang er, d isb elief , reject io n /denialandfinally acceptance.


15/43

Emo t iona l ch ang es

Usual ly tem po rary

Depending on Em otio nal Stabil i ty, pastexper ienc es, ps yc ho log ical m atur i ty, in ternalrepresenta t ion , cog ni t ive pro cess ing , t raum at ics t ressor and probably edu cat ion ?

Aw areness o f Em ot ion al react ion .

Return toward normal balance (inm ajor i ty cases)


16/43

Severe Physical / PsychologicalInjuries

Emotional Reaction

Emotional Processing

Awareness of Emotional Reaction

Returns

Towards Normal Balance(majority of cases) PTSD ( small percentage)

DEPRESSED!

?


17/43

In Facing a Serious & Critical Disease /TERMINAL Condition

To Fly (to run awayFrom the situation) To Fight (to face, to accept &to cope with the condition)

HUMAN BEING REACTION

Painful Intrusive Recollection

Human reaction would be.


18/43

STRESS/ DEPRESSION

Suppressed intoSubconsciousness- Becoming chronic- Change of value system- Reappraisal- Disturbance of emotional processing- Failure to complete the emotional processing


19/43

By Understanding The WholePsychological Process in CriticalSituation/ Terminal cancer

BETTER COMMUNICATION-Clearer-More effective & efficient communication-Honesty & openness.-Trust-Mutual respect-Politeness

- Adherence-Collaboration.-More accurate information-Prevention of violent situation-Informed consent-Legal aspects


20/43

RELA XING & CORRECT POSITION DURING M EDICAL INTERVIEW.

EQUAL (LEVEL) EYE C ONTACT.


21/43

BREAKING BAD NEWS.

EXPLANATIONPLANNINGCONDITIONING


22/43

CONSIDERATION IN BREA K ING B A D NEWS

SHOULD THE PATIENT BE TOLD : HE/ SHE ISSERIOUSL Y ILL .

HOW MUCH THE PATIENT SHOULD K NOW A B OUTHIS/ HER COND ITION.

SHOULD THE FAMILY K NOW A B OUT THE ILL NESS

HOW MUCH THE FAMILY SHOUL D K NOW THEILLNESS.

SHOUL D PATIENT K NOW THA T HIS/ HER IL L NESSCA N NOT BE TREA TED/ CURED.

HOW MUCH THE PA TIENT AND THE FAMILYSHOULD K NOW A B OUT THIS.


23/43

CONSIDERA TION IN BREA K ING B A D NEWS

DIVERGENCE BETWEEN PATIENT AND DOCTORSPERPECTIVES PATIENT & FAMILY HOPES OFGOOD NEWS. AND .DOCTORS NEWS (Tuckett et

al, 1985)The Doctor must change the newshow? MOST DOCTORS w il l f ind th is du ty v ery diff icu l t! !!

Psyc ho log ical Sequ elae of B REAK ING BA D NEWS

DEVASTATING and L ONG LA STING (Finley &Dallimore 1991). Many reports expressing doctorsdef iciencies in th is m atter.


24/43

How Muc h Th e Pat ient and The FamilyShou ld kn ow abou t the ir Cr i t ical Cond i t ion .

THE PATIENT A ND THE FA MILY SHOULD K NOWENOUGH A BOUT th eir Cri t ical Il lness/ Cond it ion.THEY SHOULD K NOW THA T THEIR CONDITION CA N

NOT/ DIFFICULT TO BE CURED, THAT THEPA TIENT WILL DIE? (THE PATIENT OR THE FAMILYONL Y ?).IN THE CA SE OF INDONESIA, PROB A B LY THEFAMILY SHOULD KNOW MORE? .

IN OTHER CO UNTRIES (USA ) THE PA TIENT MUSTB E TOL D FIRST.DO NOT EVER TELL THE PATIENT, HOW L ONG HE/SHE WILL LIVE !!!!!.


25/43

K EY CORE SKILL FOR BREAK ING B AD NEWSEXPLA NA TION & PLA NNING .

Preparat ion

Summariz ing

Negot ia t ing the A genda

Lis ten ingPick in g up Cues

The use o f Si lenc e

Discovering the patients concern and ideas

Encou raging the express ion fee lingPick in g up the non v erbal cues

Bui ld ing rappor t


26/43

K EY CORE SKILL FOR BREAK ING B AD NEWS.

Cond i t ion ingEmpathyAcceptanceDiscov er ing th e pat ien t s tar t ing p oin tDiscovering the patients feelingGauging w hat and h ow m uch in fo rm at ion to g iveDisco ver ing w hether a pat ient is a seeker or andavoider of in form ationGiv ing sup por tGiving clear jargon - f ree explanat ionChunk ing and check ing in fo rm at ion g iv ing


27/43

Sugg es t ion for B reaking B ad New s.

PREPA RATION :

- Set Up appointm ent as so on as po ssible

- Un interrupted t im e- com for table & famil iar a tmos ph ere

- Inv ite sp ou se, family , fr iend s as appro priate

- adequately p repared for pat ient b ackgrou nd, educat ion

si tuat ion, records .

- Doctor s hou ld pu t as ide personal feel ing .


28/43


29/43

PLEA SE NOTICE THE POSITION OF DOCTOR PATIENT.

IT IS CLOSER, FAMILIAR, AND THERE IS NO BARRIERBETTER.


30/43


B EGINNING THE SESSION.

- sum m arizing w here thing s have reached to date

- Discov er what has h appened s inc e las t seen- Cal ibrate how the pat ient i s th inking / feeling

- Nego tiate an ag end a.


31/43


SHARING THE INFORMATION- ASSESS THE PATIENTS UNDERSTANDING - GAUGE HOW MUCH THE PA TIENT WISHES TO KNOW- GIVE WARNING .CONDITIONING I am afraid w e have

som e bad news to te ll ; I am afraid i t loo ks mo re ser ious

than we hope - GIVE BASIC INFORMATION, simply and honestrepeat

impor tan t p o in t s .- Relate your information to the patients framework - Do no t g ive too m uch in fo rmat ion too ear ly ; do no t

p u s s y fo o t b u t d o n o t o v e rw h el m- Give inform at ion in s mal l chun ks; categorize inform at ion- Watch th e pace; check repeatedly for u nd ers tand ing, feel ing as

you p roceed.- Use proper langu age, avoid jargon !


32/43

Sug ges t ion for B reaking B ad New s.

B EING SENSITIVE TO THE PA TIENT.- Read th e non -verbal cu es : face, bo dy langu age

si lenc e, tears- Allow for shut down (when patient turn off,

s top l i s tening, s i lence) give t ime & space;al low denial .

- Keep pausing to g ive pat ient t im e to askquest ion.

- Gauge the patients need for further information pat ient w i l l react var iously, demand

differently.- Encou rage express io n of feel ing : I am sorry that was

difficult for you.


33/43

A HA UNTED SITUATION?

A PROVO CATIVE ATMOSPHERE FOR C ONSULTATION?


34/43


35/43

Sugg est ion for B reakin g B ad New s.

BEING SENSITIVE TO THE PATIENT - Respo nse to the pat ient feel ing and predicam ent wi th

acceptance, em pathy, and con cern.- Check the patients previous knowledge about the

inform at ion given.- Specifically elicit all the patients concern - Check th e und ers tandin g o f info rm at ion given, e.g . :

would you like to run through what you are going totell your wife/ family

- Be aware of u nsh ared m eaning , e.g . : w hat cancer m eansor the pat ient com pared w hat i t means to the phy sician.

- Do n ot a f raid to s how emot ion & dis t ress (phys ic ianhu m an being ) .


36/43

Sugg est ion for B reakin g B ad New s.

FOLL OW UP & CL OSING.

- Sum m arize and check w i th pat ient .- Do n ot ru sh pat ient to t reatm ent .

- Set u p ear ly fu r ther appoin tm ent , offers te leph one c alls ,

- Ident i fy su pp ort sy stems : invo lve relat ives and f r iend s,

re l igion or c ul tural leader or oth er rela ted p rofess ion al

- Offer to see/ tel l spo us e or ot hers.

- Make w rit ten m aterial available.

( Bu ck m an1994; Faulkn er 1988)


37/43

SPECIA L ISSUES

DOCTORS sh ould a lw ays ask qu es t ions forthems elves :

- Am I in po si t ion to g ive this pat ient accu rateinformat ion?

- Have I discovered the patients illnessframework : his thought, feeling ? - Have I developed su ff ic ient rappor t w i th th e

patient?.- What i s th e effect on the pat ient o f w hat I am

saying?- Am I go ing at the pace of the pat ient?- Am I being f lexible , sup po rt ive and emp athic?- Am I negot ia t ing an effect ive plan fo r the futu re?


38/43

SPECIA L ISSUES

CUL TURA L ISSUES.- Cros s Cu ltural Persp ect ive- Ethnic Com plexi ties- Do no t s tereoty pe pat ients- Cultur e is a textu red pat tern of b eliefs &

pract ices .- Patients culture provide him/her ideas about

heal th and i l lness , no t ion s abou t causal i ty, e tc

- Modern doc tors very of ten enco un ter prob lem srelat ing to c ul tu res , t radi t ion s etc .

Chu gh 1993; Myersco ug h 1992; Eleftheriadou 1996.


39/43

SPECIA L ISSUES

REL IGION A ND SPIRITUA L GUIDA NCE A REIMPORTANT FACTOR IN BREAKING BAD NEWSIN CRITICA L L Y ILL PA TIENTS, WHEN THERE IS NOMORE HOPE FROM THE POINT OF MEDICA L VIEW.

- Rel ig ion and sp i r i tua l gu idance w i l l b r ing th e

patient o ver and faster to the acceptancephase , and g iv ing up to th e Lord th e fate forthem


40/43

Painful maybe, but a good supportive communication


41/43

MA JORITY (70%) OF MEDICAL

L AW SUING IS

CA USED BY PROBL EMOF DOCTORS PATIENTS/ FA MIL IESCOMMUNICATION


42/43

Exam ples of Medical Law - Suing

Rude way of communication Mas tec tom y wi thou t b iopsy wi thou t su ff ic ien tm edical in form at ion .

Ster i l iza tion w i thou t p roper c on sent .Fai lure to d iagn os e in a very rare i l lness .

Operat ion w i thou t con sent .

Repr imand fo r doc to r wh o speak too m uch .

Mul tip le m iscondu c t o f a doc to r

Miscon duc t because of profess ion delegat ion .

Etc.


43/43

.AND MAY LORD GIVE US THE HEALERS THE STRENGTH, TO SEE OUR FEL L OW C RITICA L LY

IL L PATIENTS AS A SUFFERING HUMA N B EING,

A ND THAT THEY NEED OUR B EST EFFORT A ND

EXPERTISE TO HELP THEM OVER COMING THEIR

PROBLEMS, .AND NOT.. TO AD

THANK YOU.

1.6 Komunikasi Pada Kasus Tertentu

Documents

Transcript of 1.6 Komunikasi Pada Kasus Tertentu