Transcript Managing Difficult Conversations – Anderson

Managing Difficult
Conversations
Social Psychology 201
for ED’s
Stephen H. Anderson M.D., FACEP
President, WA State Chapter ACEP
September 24, 2012
Presented at WSHA Safe Table - ER is for Emergencies
1
Seven Conversations
• Grieving
1) Someone is dying/ died.
2) Your child is going to have a bad outcome.
Presented at WSHA Safe Table - ER is for Emergencies
2
Seven Conversations
• Sheriff/ Parenting
3) I think you have a drug/ alcohol
problem.
4) I think you’re here too often.
5) Why are you REALLY here?
Presented at WSHA Safe Table - ER is for Emergencies
3
Seven Conversations
• Colleague/ Political
6) I disagree with you as a colleague.
7) That’s not how administration foresees it.
Presented at WSHA Safe Table - ER is for Emergencies
4
Overlying Principles
• There are rules/ givens.
• You have to listen.
Presented at WSHA Safe Table - ER is for Emergencies
5
Principles
• Know your allies…
• Know their allies.
• Find your support…
• Find their support.
Presented at WSHA Safe Table - ER is for Emergencies
6
Principles
• Believe in WIN- WIN.
• To thine own self be true.
• Document.
Presented at WSHA Safe Table - ER is for Emergencies
7
There Are Rules/ Givens
• Some are hard…
• Some are soft.
• Some are “ours”…
• Some are “only mine”.
Presented at WSHA Safe Table - ER is for Emergencies
8
There Are Rules/ Givens
The Key
Ownership
Presented at WSHA Safe Table - ER is for Emergencies
9
You Have To Listen
• Conversations are two way.
• Find out their goals.
• Find out their fears.
–Give them enough rope…
Presented at WSHA Safe Table - ER is for Emergencies
10
Know Your Allies…
• Rally your troops.
• Build your allies.
Do you want to be an expert witness?
Presented at WSHA Safe Table - ER is for Emergencies
11
Know Their Allies…
• Introductions for EVERYONE.
• Note “Alleged Allies” not present
Acknowledge as appropriate.
Presented at WSHA Safe Table - ER is for Emergencies
12
Find Your Support
Find Their Support
• Key to the Grieving Conversation
• If you’re headed to war…
take them with you.
Presented at WSHA Safe Table - ER is for Emergencies
13
Believe In WIN-WIN
• Try never to define your win,
by their loss.
Presented at WSHA Safe Table - ER is for Emergencies
14
Believe In WIN-WIN
• Listen
• Repeat back
• Work toward a common goal
• Compromise?
Presented at WSHA Safe Table - ER is for Emergencies
15
To Thine Own Self Be True
• Never Lie
• Never Lie
•Never LIE!
Presented at WSHA Safe Table - ER is for Emergencies
16
These Are Difficult
Stressful
Conversations!
• Debrief
• Avoid being the one with the disease
Presented at WSHA Safe Table - ER is for Emergencies
17
Not All Conversations
Will End WIN-WIN
• Some won’t end.
• Have an exit strategy.
Presented at WSHA Safe Table - ER is for Emergencies
18
Document
• ANY conversation with “potential” is
worth documenting.
• Two documented views are better
then one.
• “They” know how to document too!
Presented at WSHA Safe Table - ER is for Emergencies
19
Someone Is Dying/ Died
• It’s someone’s job,
take ownership.
#1
• Find your support
Most
• Find their support
Important
Presented at WSHA Safe Table - ER is for Emergencies
20
Someone Died
• Focus on the closest,
talk to everyone
• Listen
• Account for beliefs/ cultures
• Physical contact, the “healing touch”.
Presented at WSHA Safe Table - ER is for Emergencies
21
Someone Died
Goals To Express
1) We did everything appropriate.
2) Address pain & suffering.
3) “Now we are here to help you…
& others.”
Presented at WSHA Safe Table - ER is for Emergencies
22
Someone Is Dying
Don’t lie
Don’t steal hope
Be realistic
Presented at WSHA Safe Table - ER is for Emergencies
23
Someone Is Dying
Listen ( Is the PATIENT speaking through an advanced directive?)
Find your support/ Find their support
Start the conversation
Geography/ proximity
Presented at WSHA Safe Table - ER is for Emergencies
24
Your Child
Is Going To Have
A Bad Outcome
• Find your support/ Find their support
• Don’t steal hope
• Be honest “in that moment”
Presented at WSHA Safe Table - ER is for Emergencies
25
Bad Outcome
Negative attitude leads to
negative outcomes…
Blame is for later
Presented at WSHA Safe Table - ER is for Emergencies
26
Bad Outcome
• Child’s safety first
• When do you include the
child in the conversation?
Presented at WSHA Safe Table - ER is for Emergencies
27
I Think You Have A
Drug/ Alcohol Problem
Society/ Legislature/ Peers now tell us
We MUST have these conversations
THIS is the pivotal time.
Presented at WSHA Safe Table - ER is for Emergencies
28
Drug & Alcohol Problems
The Principles
• There are rules/ guidelines
• Listen first
• Your allies/ their allies
“Their support” might turn out to be your best ally!”
• WIN-WIN
• Be true to yourself
Presented at WSHA Safe Table - ER is for Emergencies
29
Drug & Alcohol
Tools to Help
• Old Records
• EDIE
• WA state Prescription Monitoring Program
Educate patients that these exist
Presented at WSHA Safe Table - ER is for Emergencies
30
I Think You’re Here Too Often
PRC
Patient’s
Requiring
Co-ordination
Presented at WSHA Safe Table - ER is for Emergencies
31
You’re Here Too Often
New WA Hospital Requirements
• Identify PRC clients upfront
• Notify their PCP of visit
• Discharge patient with instructions along:
“the right patient-to the right place-at the right time”
Shouldn’t be a punitive discussion
Presented at WSHA Safe Table - ER is for Emergencies
32
You’re Here Too Often
“You’re Unique, but…”
Educate
“The Econ Lecture”
Presented at WSHA Safe Table - ER is for Emergencies
33
Why Are You REALLY Here?
• Constructively focuses the scatter.
• Gives an opening to the REAL difficult
conversation.
NEVER demean the answer
Presented at WSHA Safe Table - ER is for Emergencies
34
I Disagree With You
As A Colleague
Fatal Error VS. Difference Of Opinion
Fatal Error
Success comes through education first
Presented at WSHA Safe Table - ER is for Emergencies
35
Difference of Opinion
With A Colleague
Praise in Public/ Debate in Private
Ask yourself going in:
What’s my goal?
Am I a team builder?
How can I make this WIN-WIN?
Focus on the patient
Presented at WSHA Safe Table - ER is for Emergencies
36
Difference Of Opinion
With A Colleague
• Listen
• Agree on the easy, Work toward the hard.
• Set the stage for “The Next Time”
• If necessary, use the chain of command.
Presented at WSHA Safe Table - ER is for Emergencies
37
That’s Not How
Administration Foresees It
Presented at WSHA Safe Table - ER is for Emergencies
38
Administration’s Viewpoint
The Golden Rule
1)
Do unto others, as you would have others
do unto you.
2) Those with the gold, make the rules.
Every pathway has an economic angle.
Presented at WSHA Safe Table - ER is for Emergencies
39
Administration’s Viewpoint
What brought you to the table?
1)
What do they need from you?
2)
What motivates you?
Principles
Priorities
Presented at WSHA Safe Table - ER is for Emergencies
40
Administration’s Viewpoint
Great leaders
get input from
great followers
Presented at WSHA Safe Table - ER is for Emergencies
41
Managing Difficult
Conversations
• There are rules/ givens
• You have to listen
• Know your allies/ know their allies
Find your support/ find their support
• Believe in WIN-WIN
• To thine own self be true
• Document
Presented at WSHA Safe Table - ER is for Emergencies
42