CEP SESSION ETHICS 2
COMMUNICATION ESSENTIALS OF BREAKING BAD NEWS AND SERVICE RECOVERY
BY DR LEE SEE MUAH & MS MALEENA SUPPIAH
27TH FEBRUARY 2015 12 3PM -
Welcome to a learning session on the essentials of communication. Below is a video on breaking bad news. Please click below to watch the 12minute video. The learning objectives are clearly stated & the concepts & illustrations will help you in the case study discussions that follow.
CASE 1 Mdm Chan a 75 year old fell and had a right hip fracture. She was admitted to the hospital and had a hip replacement done. During the fifth post-operative day, she was started on physiotherapy. She had pains which she kept to herself until two days later when she told her physiotherapist about it. She was told to persevere and to “increase her pain threshold” for her own good. She was subsequently discharged to the community hospital. In the hospital, the pain was so severe that she was confined to bed. Her daughter visited her on the same night she was transferred and notice swelling of her right thigh. She was brought straight away to the hospital where her hip was diagnosed as “having popped out” and it would be quite easy to “pop it back”.
EXERCISE The daughter is very upset and angry with the hospital for failing to diagnose her mother’s complication. Participants will role play in groups of two. One as the daughter, the other as the doctor tasked to meet and explain to the patient. How would you apply the skills of ASSIST to manage the communication with the patient and her daughter?
CASE 2
Mr PC, a 52 year was re-routed from a tertiary hospital (X) to a secondary hospital (Y) for social admission on 28 November 2011 pending availability of nursing home placement. He was diagnosed as having had a stroke more than one year ago, as indicated by CTScan done at another tertiary hospital (Z) at that time showing an intra-axial bleed in the region of the right thalamus, with intraventricular extension. Surrounding parenchymal edema and local mass effect with hydrocephalus was also noted. Carotid angiogram done at that time also indicated a thalamic bleed. His hospital stay in Y Hospital was marked by an overall decline, weakness, poor bladder control and tremors. However, there was evidence of fluctuation of his condition on certain days between improvement and deterioration. Psychiatrist opinion attributed his symptoms to depression due to stroke. Thus, all these taken together, a decision for MRI was considered but not taken at this stage. Preparations were made for his transfer to a nursing home on 7 February 2012. On 3 February, the patient had stiffening of both the upper and lower limbs. His condition at that time was described as alert and conscious. On 4 February, he deteriorated acutely and was unable to swallow, thus necessitating NG tube insertion. MRI was ordered, but patient’s brother was not available to come down to give consent.
CASE 2 CONTINUED
On 5 February, patient developed right sided neglect and was stiff over 4 limbs. MRI was urgently carried out. MRI done 5 February 2012 showed a large heterogeneous mass involving the left frontal lobe and para-falcine regions of bilateral frontal lobes, bilateral basal ganglia and thalami. The lesion measures approximately 7.9 x 8.5 cm in size. Debulking of the tumor was carried out urgently on the same day. Post-operatively, the patient remained unconscious. Records indicated that the patient’s brother had at various times communicated with the doctors. However, his concerns were not relayed to the team as effectively as it should have been. Disclosure and discussion with family The brother is now very upset and angry with the treating team. He felt that his complaints were disregarded till the very last moment when the symptoms were obvious. He wants to know why the tumor was not picked up earlier. He has consulted other doctors who say that an earlier diagnosis with treatment before the patient became so bad might have given better chance of a better quality of life for the brother.
Exercise One of you will act as the brother who is angry and upset. One will act as the doctor discussing with the brother of the patient. Use the ASSIST model to assist with the conversation.
Service Recovery
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for narrated slides
(8 mins 40 secs)
Additional Resources Please click below to listen to the podcast