1 difficult medical consultation restoration plus our strength dr. ares leung deputy medical...
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Difficult Medical ConsultationRestoration plus Our Strength
Dr. Ares Leung
Deputy Medical Director
Union Hospital
2012
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Why are clients “difficult”?
Management of Difficult Medical Consultation
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Management of Difficult Medical Consultation
Stress from disease, anxiety: illogical response stimulated
Loss (potentially major, real, future, imagined): Grief response
Ignorance / Lacking knowledge (education focus of doctors needed)
Mismatched Expectation: hope for cure / perfection (cost – financial, material, convenience, big ego, etc) mismatch and high; unexpected interaction (e.g., ‘wrong’ gender of doctor)
Lack of social & communication skill (‘family education’, society tendency to challenge and say no, failure to recognize that the social approach causes problems, long-windedness)
Deliberate: see how the doctor respond, personal gain, inappropriate intentions (one extreme: seducing)
Reasons for clients to be difficult
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Model of a muscular doctor: The rationale
We are doctors who are brave intellects
Patient statusFriendsAllies of self
We do not bend our back in relation to extrinsic factors…
…nor change our care due to intrinsic factors
Convenience
Material gain Financial return
Self-InterestFACE
Value
CompetenceExperience
Pressure
Request
Begging
5Building your strengths is crucial
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Management of Difficult Medical Consultation
Power to
educate
Support from
colleagues
Home match
The Rationales
智者不惑勇者不懼 仁者無敵
Strength: Model of a muscular doctor
We are stronger at home
Use the powerthat society allows us to teach & change
We gain strengthThro’ mutual support
Core Fitness
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Model of a muscular doctor: The rationales
Power to educate
Support from
colleagues
Home match
The Rationales智者不惑勇者不懼仁者無敵
Core Fitness
• Fundamental duty of doctor
• not to decide or intervene but to find out, analyze, explain and educate on the truth, all the truth and nothing but the truth
• I am only a doctor but I am still a doctor
• A leader but not a dictator
The rationales hold the fundamental duty of a doctor
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Restoration to Home Match
Restoration: The best way to handle a difficult consultation is to change it into a normal familiar one.
Analogy with difficult surgery: Most important work at startThe best solution is to restore normal anatomy
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Home match
Power to educate
Support from
colleagues
Home match
The Rationales智者不惑勇者不懼仁者無敵
Restoration: key to a normal consultation
We are stronger at home
Change the settings back to a familiar usual consultation.
When presented with Bewildering information (excessive, e.g., patients studying over the web, health care professionals), return to our own pace and solve problems at our choice of method
Go by methods of the client if it is still comfortable to doctor, but change if not comfortable
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The concept of home match
Preservation of important elements with regular consultations.
Stay positive in our tone, posture, active listening Express confidence Show empathy and sympathy: reflection of understanding
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Use negotiation and communication techniques to overcome dead-locks
4 Identify areas of difference Prioritize issues of discussion Watch out for non-verbal clues Connect behaviors to feelings
Control to the long winded.
2 Explicit acknowledgement to facts, relations and feelings Use body language to stop repetition or to encourage dialogue Ask Questions & give instructions to direct flow, but with care
Process techniques to control flow without use of power
3 Deal with emotion, control overreaction Maintain appropriate direct dialogue Search for common interest
Home match
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Model of a muscular doctor in a Home match
Communication techniques Some useful dialogues
Identify areas of difference “ it seems your priorities are…”
Prioritizing issues of discussion “what is the most important part of this problem…”
“should we first focus on…, and then we shall come back to other problems”
Focusing “wait a minute, we seem to be losing what we are talking about”
Non-verbal clues “you seem not interested in this solution, (you are a bit quiet here)..”
Connecting behaviour to feelings
“whenever we talk about this, you seem worried in the face, restless…”
Practice service dialogue to sharpen your communication
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Model of a muscular doctor in a Home match
Know the Do’s and Don’ts of a normal consultation
Do’s
Stay positive in communication Engage client and accompanying
people in communication Explain on basis of facts, evidence Empathy: not an act, but a true
concern List solutions, explain pros and cons, Let the patient decide
Don’ts
React Argue Reject Push Escalate (conflict and emotion) Just pronounce for creditability Speculate (tell only confident,
honest and factual answers) Yield to inappropriate demands:
use ‘no’ sensibly
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Model of a muscular doctor: Power to educate
Power to
educate
Support from
colleagues
Home match
The Rationales智者不惑勇者不懼仁者無敵
Educate to achieve mutual satisfaction, not victory
UUse the power that society allows us to teach & change
MManage expectations Explain in full Context in best interest of patient
Technical intervention is only part of care
Do not overstate the success of intervention
Charges do not go too high
IInvolve patient (and families) in decision making
AArrange objective provision of independent second, third or even forth opinion if needed.
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Model of a muscular doctor: Support from colleagues
Power to educate
Support from
colleagues
Home match
The Rationales智者不惑勇者不懼仁者無敵
Engage colleagues, same specialty and/or other specialty
We gain strength thro’ mutual support
Refer to friends for independent second opinion
At time of complaint: always engage independent third party
Refer to public service when in need and no urgency for immediate care.
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Handling disagreement
What if disagreement persists despite continuous effort?
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Handling disagreement
Learn to say a good “NO”
Usual approach:
I think what you are wrong - Direct confrontation
I have power not to go according to your request
“There are only these people who would try to please you, and I am not that fortunate to be so privileged. They are: your parents, your spouse, your children; NOT ME”
“The society has not granted me this power to do what you demanded from me, sorry.”
“I shall never cheat you, so I cannot cheat anyone else (but be careful with words such as cheating).”
“I tell this 唔啱聽 to you, but it is all for your own good.”
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Our duties: tell all information
including the not-so-good outcome
try the best to avoid adversity, but we cannot guarantee it
Patient need to balance between the goal of the intervention versus risks, not just to concentrate on risks
We need to tell patients:
1) “every doctor has complications, and “I myself” is no exception (image of objectiveness). Better doctors have a lower complication rate, but still see complications when they do enough.”
2) Then systematically and logically explain chance of adversity
Consent without fears
Handling disagreement
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Terminate the doctor patient relationship tactfully
Handling disagreement
Frank description/ communication
Explain the decision (best interest of pt.)
Make sure no immediate health risk
Offer a fair referral letter to public service
Give as much info (accompany pt if possible)
Reassure pt that he can return in future
Be polite, professional. Keep our smile.
Bid farewell and ask nurse to escort pt. out
Keep a good record (why termination)
Maintain expression of regret (sorry)
*Do not threaten patient with high fees
NNote:
DDecline to specific treatment does not necessarily lead to termination of relationship.
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Handling disagreement
Mutual disagreement is not a challenge if we know how to deal with it.
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Key Learning
Power to educate
Support from
colleagues
Home match
The Rationales智者不惑勇者不懼 仁者無敵
Do get yourself familiar with the model of a muscular doctor
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Thank you !
Dr. Ares Leung
Deputy Medical Director
Union Hospital