Kavya KurkalSeth GS Medical College
CONVEYING SENSITIVE INFORMATION TO THE
PATIENT AND THE FAMILY
WHAT NOT TO DO
6 STEP PROTOCOL1. Getting started2. What does the patient know?3. How much does the patient want to know?4. Sharing the information5. Responding to patient and family feelings6. Planning and follow up
Taken from ‘ How to Break Bad News: A Guide for Health Care Professionals’ by Robert Buckman
DEATH
For the benefit of the patient’s family and friends
WHY?
For the benefit of the doctor
For the benefit of the medical student
HOW?Here are a few basic steps to follow:
PREPARATION• Should know the history of the case• Should be able to explain in simple terms• Should be armed with answers to all possible
questions• Should remain calm and composed• Should not appear impersonal or disinterested
METHODS:There are two methods available:
In Person Telephonically
CONDITION UPDATES:
• Many families express anger and feelings of helplessness• Keep family updated during
resuscitation• Balance the needs of the patient and
family
RESPONSIBILTY OF COMMUNICATING DEATH
It is the responsibility of the physician who has been
treating the patient and this responsibility should not be delegated to anyone else unless absolutely necessary.
WHEN IS THE ‘RIGHT’ TIME?
There is no such thing as the ‘perfect’ moment.Try to break it down gently . Do not be in a hurry or abrupt.
MANNER OF CONVEYANCE
• Medical facts are less important than compassion• Do not go into the technical details• Give them time and space• It is their right to ask as many questions as they
want• It is left to the discretion of the doctor as to how
much information to divulge and to maintain a balance
• Try to inform all the family members in a group
FAMILY REACTION
DENIALGUILT
ACCEPTANCE
SORROW
ANGERDEPRESSION
VIEWING THE BODY
• Necessary evil• Prepare the body• Families of mutilated patients should be warned• Viewing can done individually or in a group
privately• If patient is a child, wrap in blanket and give
parents opportunity to hold child
CONCLUDING THE PROCESS
Effective communication continues beyond this as there are a few issues left to be dealt with by the family. The family members should be encouraged to contact the doctor if any queries arise.
• Mortuary• Autopsy• Tissue and organ donation
Let the family know that they can stay at the hospital for as long as they want
DEATH OF A CHILDIt is a particularly sensitive situation.
• Give parents enough time to hold child• Religious preferences and ceremonies• Information to nursing mothers• Informing the child’s sibling• Offer to preserve momentos
RED FLAG SIGNS
AFTER DEATH
• The practice of using the newly dead for the purpose of medical research and advancement has met with increasing controversy
• Problems of disclosure and informed consent• Difficult to approach a grieving family• Other ethical issues arise from cultural differences
in treating the body of the newly dead• Currently no universal guidelines or official
policies regarding this practice exist.
ROLE OF THE MEDICAL STUDENT
• Importance of providing appropriate and adequate training to medical students in patient communication
• Students should be allowed to accompany the physician while disclosing sensitive information
• Students should be encouraged to discuss the experience with the physician
• Student must not be made to convey information to the family directly
• The houseman should actively participate in such conveyance as part of his training albeit under supervision initially.
CONCLUSION
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