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Breaking Bad News An Essential skill to be acquired by every gynaecologist . Dr. DR. Sharda Jain ,

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Lifecare Centre

This document discusses breaking bad news to patients in the field of gynecology. It notes that delivering bad news is a difficult but essential skill for gynecologists. Examples of bad news include cancer diagnoses, infertility issues, stillbirths, neonatal deaths, and deaths on the operating table. The document provides guidelines for how to effectively break bad news, including preparing in advance, building rapport with patients, communicating clearly and empathetically, addressing emotional reactions, and encouraging acceptance. It emphasizes the importance of communication skills, sensitivity, and maintaining composure in difficult situations.

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Breaking Bad News An Essential skill to be acquired by every gynaecologist Dr. Sharda Jain Director s:
I Dedicate this PPT to my Colleagues & Patients Review This Lecture at slideshare.net
Professional life is like a game Some time you win At other time you lose You have to take it in your stride …
EVER SINCE THE SUPREME COURT BROUGHT THE PATIENT – DOCTOR RELATIONSHIP UNDER THE AMBIT OF THE CONSUMER PROTECTION ACT IN 1995, THE NUMBER OF COMPLAINTS AGAINST DOCTORS HAS GONE UP in India
Deliver Best to T he Patients Do No Harm
Human Emotions are Most Difficult to Predict , especially in a STRESSFUL environment in hospitals & clinics
MOST SUCCESSFUL DOCTORS are those who have Breaking Bad News Good communication skills. Mandatory to learn SOFT SKILLS how to BBN to patients & family
Concerns & Realities Walk into the major LABOUR WARD of any government hospital, and you’re likely to find patients / relatives VERY CRITICAL with treatment given.
Concerns & Realities In the CANCER WARD, families of patients complain • Doctors don’t offer much advice • Alternatives are not detailed • How to manage the debilitating pain associated with the disease.
“At times , causalities happen & doctors end up having ”RUDE & UNCARING“ Behavior of public Kerela Gynaecologist beaten – up August 2014
What do you Think is BAD NEWS ? • What is bad news? • What went wrong? • Could it be avoided. • How will you react – if you were the patient or relative ?
What is bad News? It is any information which is Likely to • ALTER DRASTICALLY A PATIENTS VIEW OF THE FUTURE all together … * • ALTER PATIENT’S LIFE ALL TOGETHER
VARIOUS IDEAS on BAD NEWS? • Feeling of NO HOPE, • A threat to a person’s MENTAL OR PHYSICAL WELL BEING • A risk of Upsetting An Established Lifestyle or • Left with fewer choices in her life (ptacek & Eberhardt TL, 1996) • News that drastically and negatively alters her or his future” (Buckman, 1984)
BAD NEWS in O/G ? STIGMATIZATION HIV ----------------------------------------------------------------------------------------------------------------------------------- INFERTILITY -------------------------------------------------------------- • Azoospermia • B/L patent tubes • IVF failure UNFAVORABLE DIAGNOSIS ------------------------------------------- ------------------------------------------------------------------------------- Irreversible , un-treatable or non-stoppable disease / side effects/ complications CANCER ------------------------------------------- ---------------------------------------------------------------------------------------- YOUNG AGE Recurrence Spread of disease Late stage PREGNANCY DEATH ---------------------------------------------------------------------------------------------- • STILL BIRTH • NND in 1st 24 hrs • Rec. Mole • Rec. Pregnancy Los DEATH / DOT
Various Situations Faced by We Gynaecologists Bad Diagnosis CANCER INFERTILITY Azoospremia Still Birth B/L Block Tubes DOT NND IVF failure Death in O/G Rec. Endometriosis Miscarriage Cerebral palsy Thala. Major
Bad News Any of these Condition has potential to surprise the Great gynaecologists by sudden occurrence. Bad news will occur in spite of taking all pro-active precautionary measures. Although awareness and readiness to face and tackle all possible mishaps would minimize complications, to a large extent. However it cannot always be eliminated all together.
INFORMED CONSENT Is to be taken seriously o Is vital for gynaecologists to fully understand the importance of counseling & take STD / High Risk consents Video Recording (if smelling problems !!)
DEATH on Operation Table (DOT) in O/G is extreme rarity
DOT Seen occasionally 80/20
DOT/ Still Birth It is like death in police custody where there is no help for patient & nobody knows the facts except doctors & their team. Arrest
1 Real Life Incidents PGI Chandigarh 52 years, Doctor's aunt came with PM bleeding. Patients had no co-morbidity All tests were normal from pre OT area patient was shifted on trolley and before she could be transferred on OT table - she was NO MORE
DEATH Obstetrics / Gynaecology Is no joke !!!
A Gynaecologist is caught at least once in lifetime in this tragedy !!
Real Life Incidents Primi. had elective LSCL for breach After smooth surgery had pulmonary odema & died
Biggest Bombshell Still Birth at term or NND in 24hrs. Litigation + + +
Recurrent Miscarriage Recurrent IVF Failures CANCER Young age Last stage Recurrence REQUIRES CAREFUL HANDLING
“Ending Treatment” When to advice patients that “enough is enough” Cancer Infertility Rec. Miscarriage Endometriosis
Cause of Litigations Is * Lack of Empathy * Lack of Good Communication skills • Over work • Over tired • Explained before Are Silly Doctor’s Excuses
Emotional Responses to a bad News • Denial • Despair • Anger • Bargaining • Depression • Acceptance S upport Sys tems from doctor is must
Breaking some BAD NEWS for us! Is the MOST DIFFICULT TASK !!
Why Difficult • Both Party are UPSET • NOT PLEASANT task by doctors • TAXING for both (BBN / receiving BN ) • LOUSY JOB has long lasting impact & repercussion. This ART – We All Have to Learn it
Doctors - today are realizing that they have to deliver Bad News / Diagnosis with care Breaking Bad News is an ART
Soft skills of BBN are NOT Taught in Medical Colleges YOU ARE LUCKY TO HAVE GOOD BOSS / MENTOR !!
Doctors need to polish soft skills to Deliver “Tough” Bad News Strategies Challenges
ABCDE our second choice A- ADVANCE PREPARATION B- BUILD ENVIRONMENT / RELATIONSHIP C- COMMUNICATION WELL D- DEAL WITH REACTION E- ENCOURAGE & VALIDATE EMOTIONS
BLAT • BUILD TRUST • LISTEN , • APOLOGIZE, • THANKS Is our 1st choice “in our practice it helps us in dealing with difficult situations and breaking bad news
Other Practical Approaches to BBN SPIKES BREAKS Setting and listening skill B- BACGROUND Patient perception R- RAPPORT Invitation to give E- EXPLORE Information A- ANNOUNCE Knowledge K – KINDLING Explore Emotion & S- SUMMARIZE Empathize Strategy and summarize
Practical Tips For Great Interview
Keep a Bold Face !! • Preserve maintain reasonable EMOTIONAL BALANCE • Preserve a satisfactory SELF – IMAGE and sense of Competence. Never worry, “Be concerned”
What are we worried ABOUT - DOT/ Death/ Still Birth • Breaking the news • Damage to reputation • Facing questions of relatives • Fear of mob violence • Handling police enquiry • Medico-legal issues – arrest, courts, case, judgment… • Compensation amount • Loss of confidence • Stress in future cases
How to Handle The Situation… Death / DOT / Still Birth  Gather  Ask for help.  Relax  Review sequence of events  Do not adopt a “Blame Culture”  Proper documentation  No discrepancies in records  No comments by junior staff Never worry, “Be concerned”
Communication is two way Process
Communication Skills  Good & honest communication by Sr. & Reputed Consultant can prevent litigation  RELATIVES WANT to know TRUTH  Sympathetic approach  Be honest
Anticipate Reactions of Patient / Relatives & handle it well  Shock  Pain  ANGER  Guilt DEPRESSION
Communication Skills • Avoid aggression or putting blame on relatives • Staff should not contradict statements made by consultants to avoid misinterpretation by relatives. • Do not refuse to give records or refuse postmortem, rather suggest it from your side.
Being Sensitive to Verbal & Nonverbal Language of the patients & Relatives  While you proceed read the non-verbal clues; face/body language, silence, tears  Give time & space:  EMOTIONAL DISCHARGE  Give opportunity to ask questions
Strategies for coping crisis in infertility/ IVF /obstetrics Meaningful 1st Counseling of couple biggest tip Be mentally prepared to ACCEPT FAILURE After crisis – problem focused BBN 1. EMOTIONAL DISCHARGE 2. Encourage CALM ACCEPTANCE 3. Be a PROBLEM SOLVER 4. Explain ALTERNATIVES
BBN in pregnancy / Infertility is all together different game !! “Their first reaction is disbelief, then blame and anger .. as a doctor, don’t say anything , just hold their hand and let them vent their anger . They generally come back and talk to you after a while”
Relaxation technique & psycho therapeutic counseling Helplessness • Help her to speak - up • Improve decision making skill •Advice for treatment holidays • Problem solving skill • Benefits of physical well – being • Nutrition. • Spiritual counseling Acceptance doctor you are Great !! Now - I can handle the problems related to my infertility / Pregnancy Loss
BBN for “Ending Treatment” is Another big task * A patient – centered emotionally focused approach is the key * Help the patient set the agenda •Help them to find MEANING IN LIFE , •Assist them in redefining goals • To promote long term adjustment in life by examples
Last, But Not The Least….. Every new day brings CHALLENGES AND OBSTACLES  Stop thinking about it constantly at HOME  Keep your morale & self confidence intact  Learn the lesson it teaches  Take a small break
Arrange Soft Skill Workshops for gynaecologists Leaders to speak Experience Sharing Role Plays
Creative workshop for Doctors & Medical Students to make them • Expressive • Empathetic • Concerned • But bold & self confident
Left you with many Q unanswered
ADDRESS 11 Gagan Vihar , Near Karkari Morh Flyover Delhi -51 CONTACT US 9650511339 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com

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Breaking Bad News An Essential skill to be acquired by every gynaecologist . Dr. DR. Sharda Jain ,

  • 1. Breaking Bad News An Essential skill to be acquired by every gynaecologist Dr. Sharda Jain Director s:
  • 2. I Dedicate this PPT to my Colleagues & Patients Review This Lecture at slideshare.net
  • 3. Professional life is like a game Some time you win At other time you lose You have to take it in your stride …
  • 4. EVER SINCE THE SUPREME COURT BROUGHT THE PATIENT – DOCTOR RELATIONSHIP UNDER THE AMBIT OF THE CONSUMER PROTECTION ACT IN 1995, THE NUMBER OF COMPLAINTS AGAINST DOCTORS HAS GONE UP in India
  • 5. Deliver Best to T he Patients Do No Harm
  • 6. Human Emotions are Most Difficult to Predict , especially in a STRESSFUL environment in hospitals & clinics
  • 7. MOST SUCCESSFUL DOCTORS are those who have Breaking Bad News Good communication skills. Mandatory to learn SOFT SKILLS how to BBN to patients & family
  • 8. Concerns & Realities Walk into the major LABOUR WARD of any government hospital, and you’re likely to find patients / relatives VERY CRITICAL with treatment given.
  • 9. Concerns & Realities In the CANCER WARD, families of patients complain • Doctors don’t offer much advice • Alternatives are not detailed • How to manage the debilitating pain associated with the disease.
  • 10. “At times , causalities happen & doctors end up having ”RUDE & UNCARING“ Behavior of public Kerela Gynaecologist beaten – up August 2014
  • 11. What do you Think is BAD NEWS ? • What is bad news? • What went wrong? • Could it be avoided. • How will you react – if you were the patient or relative ?
  • 12. What is bad News? It is any information which is Likely to • ALTER DRASTICALLY A PATIENTS VIEW OF THE FUTURE all together … * • ALTER PATIENT’S LIFE ALL TOGETHER
  • 13. VARIOUS IDEAS on BAD NEWS? • Feeling of NO HOPE, • A threat to a person’s MENTAL OR PHYSICAL WELL BEING • A risk of Upsetting An Established Lifestyle or • Left with fewer choices in her life (ptacek & Eberhardt TL, 1996) • News that drastically and negatively alters her or his future” (Buckman, 1984)
  • 14. BAD NEWS in O/G ? STIGMATIZATION HIV ----------------------------------------------------------------------------------------------------------------------------------- INFERTILITY -------------------------------------------------------------- • Azoospermia • B/L patent tubes • IVF failure UNFAVORABLE DIAGNOSIS ------------------------------------------- ------------------------------------------------------------------------------- Irreversible , un-treatable or non-stoppable disease / side effects/ complications CANCER ------------------------------------------- ---------------------------------------------------------------------------------------- YOUNG AGE Recurrence Spread of disease Late stage PREGNANCY DEATH ---------------------------------------------------------------------------------------------- • STILL BIRTH • NND in 1st 24 hrs • Rec. Mole • Rec. Pregnancy Los DEATH / DOT
  • 15. Various Situations Faced by We Gynaecologists Bad Diagnosis CANCER INFERTILITY Azoospremia Still Birth B/L Block Tubes DOT NND IVF failure Death in O/G Rec. Endometriosis Miscarriage Cerebral palsy Thala. Major
  • 16. Bad News Any of these Condition has potential to surprise the Great gynaecologists by sudden occurrence. Bad news will occur in spite of taking all pro-active precautionary measures. Although awareness and readiness to face and tackle all possible mishaps would minimize complications, to a large extent. However it cannot always be eliminated all together.
  • 17. INFORMED CONSENT Is to be taken seriously o Is vital for gynaecologists to fully understand the importance of counseling & take STD / High Risk consents Video Recording (if smelling problems !!)
  • 18. DEATH on Operation Table (DOT) in O/G is extreme rarity
  • 20. DOT/ Still Birth It is like death in police custody where there is no help for patient & nobody knows the facts except doctors & their team. Arrest
  • 21. 1 Real Life Incidents PGI Chandigarh 52 years, Doctor's aunt came with PM bleeding. Patients had no co-morbidity All tests were normal from pre OT area patient was shifted on trolley and before she could be transferred on OT table - she was NO MORE
  • 22. DEATH Obstetrics / Gynaecology Is no joke !!!
  • 23. A Gynaecologist is caught at least once in lifetime in this tragedy !!
  • 24. Real Life Incidents Primi. had elective LSCL for breach After smooth surgery had pulmonary odema & died
  • 25. Biggest Bombshell Still Birth at term or NND in 24hrs. Litigation + + +
  • 26. Recurrent Miscarriage Recurrent IVF Failures CANCER Young age Last stage Recurrence REQUIRES CAREFUL HANDLING
  • 27. “Ending Treatment” When to advice patients that “enough is enough” Cancer Infertility Rec. Miscarriage Endometriosis
  • 28. Cause of Litigations Is * Lack of Empathy * Lack of Good Communication skills • Over work • Over tired • Explained before Are Silly Doctor’s Excuses
  • 29. Emotional Responses to a bad News • Denial • Despair • Anger • Bargaining • Depression • Acceptance S upport Sys tems from doctor is must
  • 30. Breaking some BAD NEWS for us! Is the MOST DIFFICULT TASK !!
  • 31. Why Difficult • Both Party are UPSET • NOT PLEASANT task by doctors • TAXING for both (BBN / receiving BN ) • LOUSY JOB has long lasting impact & repercussion. This ART – We All Have to Learn it
  • 32. Doctors - today are realizing that they have to deliver Bad News / Diagnosis with care Breaking Bad News is an ART
  • 33. Soft skills of BBN are NOT Taught in Medical Colleges YOU ARE LUCKY TO HAVE GOOD BOSS / MENTOR !!
  • 34. Doctors need to polish soft skills to Deliver “Tough” Bad News Strategies Challenges
  • 35. ABCDE our second choice A- ADVANCE PREPARATION B- BUILD ENVIRONMENT / RELATIONSHIP C- COMMUNICATION WELL D- DEAL WITH REACTION E- ENCOURAGE & VALIDATE EMOTIONS
  • 36. BLAT • BUILD TRUST • LISTEN , • APOLOGIZE, • THANKS Is our 1st choice “in our practice it helps us in dealing with difficult situations and breaking bad news
  • 37. Other Practical Approaches to BBN SPIKES BREAKS Setting and listening skill B- BACGROUND Patient perception R- RAPPORT Invitation to give E- EXPLORE Information A- ANNOUNCE Knowledge K – KINDLING Explore Emotion & S- SUMMARIZE Empathize Strategy and summarize
  • 38. Practical Tips For Great Interview
  • 39. Keep a Bold Face !! • Preserve maintain reasonable EMOTIONAL BALANCE • Preserve a satisfactory SELF – IMAGE and sense of Competence. Never worry, “Be concerned”
  • 40. What are we worried ABOUT - DOT/ Death/ Still Birth • Breaking the news • Damage to reputation • Facing questions of relatives • Fear of mob violence • Handling police enquiry • Medico-legal issues – arrest, courts, case, judgment… • Compensation amount • Loss of confidence • Stress in future cases
  • 41. How to Handle The Situation… Death / DOT / Still Birth  Gather  Ask for help.  Relax  Review sequence of events  Do not adopt a “Blame Culture”  Proper documentation  No discrepancies in records  No comments by junior staff Never worry, “Be concerned”
  • 42. Communication is two way Process
  • 43. Communication Skills  Good & honest communication by Sr. & Reputed Consultant can prevent litigation  RELATIVES WANT to know TRUTH  Sympathetic approach  Be honest
  • 44. Anticipate Reactions of Patient / Relatives & handle it well  Shock  Pain  ANGER  Guilt DEPRESSION
  • 45. Communication Skills • Avoid aggression or putting blame on relatives • Staff should not contradict statements made by consultants to avoid misinterpretation by relatives. • Do not refuse to give records or refuse postmortem, rather suggest it from your side.
  • 46. Being Sensitive to Verbal & Nonverbal Language of the patients & Relatives  While you proceed read the non-verbal clues; face/body language, silence, tears  Give time & space:  EMOTIONAL DISCHARGE  Give opportunity to ask questions
  • 47. Strategies for coping crisis in infertility/ IVF /obstetrics Meaningful 1st Counseling of couple biggest tip Be mentally prepared to ACCEPT FAILURE After crisis – problem focused BBN 1. EMOTIONAL DISCHARGE 2. Encourage CALM ACCEPTANCE 3. Be a PROBLEM SOLVER 4. Explain ALTERNATIVES
  • 48. BBN in pregnancy / Infertility is all together different game !! “Their first reaction is disbelief, then blame and anger .. as a doctor, don’t say anything , just hold their hand and let them vent their anger . They generally come back and talk to you after a while”
  • 49. Relaxation technique & psycho therapeutic counseling Helplessness • Help her to speak - up • Improve decision making skill •Advice for treatment holidays • Problem solving skill • Benefits of physical well – being • Nutrition. • Spiritual counseling Acceptance doctor you are Great !! Now - I can handle the problems related to my infertility / Pregnancy Loss
  • 50. BBN for “Ending Treatment” is Another big task * A patient – centered emotionally focused approach is the key * Help the patient set the agenda •Help them to find MEANING IN LIFE , •Assist them in redefining goals • To promote long term adjustment in life by examples
  • 51. Last, But Not The Least….. Every new day brings CHALLENGES AND OBSTACLES  Stop thinking about it constantly at HOME  Keep your morale & self confidence intact  Learn the lesson it teaches  Take a small break
  • 52. Arrange Soft Skill Workshops for gynaecologists Leaders to speak Experience Sharing Role Plays
  • 53. Creative workshop for Doctors & Medical Students to make them • Expressive • Empathetic • Concerned • But bold & self confident
  • 54. Left you with many Q unanswered
  • 55. ADDRESS 11 Gagan Vihar , Near Karkari Morh Flyover Delhi -51 CONTACT US 9650511339 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com