Transcript Document

Communicating With Chronic Pain
Patients
Drs. Wesley Buch & David Hunt
www.pspbc.ca
Format
 Interactive Format
 Four Scenarios
 Three Repeating Questions
› What’s Wrong Here?
 Patient Feels?
 Physician Feels?
› What Would You Do Differently?
› What Do We Suggest?
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What’s wrong here
Scenario 1
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What would you do differently?
Scenario 1: The Wound Up - Gobbledygook Physician
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What do we suggest?
 Prepare yourself for patient in minute
before entering office
› “wind up” is contagious
› “wind down” starts with physician
 Look at the patient.
 Talk slowly. Move slowly.
 Focus on one or two major problems
› make arrangements to see again for
other problems.
The Wound Up - Gobbledygook Physician
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What do we suggest?
 Speak slowly in ordinary language at
patient’s level of understanding
 Teach back technique (patient)
 Invite a family member or friend to attend
 Refer to Patient Self-Management & Health
Literacy Module
The Wound Up - Gobbledygook Physician
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What’s wrong here
Scenario 2
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What would you do differently?
Scenario 2: The Frustrated – Stuck Physician
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What do we suggest?
 Look for cues in yourself of feeling angry
 Check & drop your biases at door
 Deliberately choose an empathic approach
 Consult – you’re not alone.
 Sample script
The Frustrated - Stuck Physician
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Empathic script for frustrated physician
 “I can see you’re still in a lot of pain. That must
be so frustrating for you. It’s frustrating for me
too & I don’t have your pain. I think we’re both
feeling stuck.” (joining)
 “Trying new strategies takes time and small
steps. As I’ve explained, when you engage in
paced activity you will strengthen your body so
that you can do more than you’re doing now
without pain flare-ups.”
 “You might already know what to do but you
worry about moving more because of pain or
even re-injury.” (fears, catastrophizing)
 “So let’s look at what part of our plan isn’t
working yet.” (problem-solving)
The Frustrated - Stuck Physician
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What’s wrong here
Scenario 3
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What would you do differently?
Scenario 3: The Argumentative Patient
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What do we suggest?
 Do not personalize or become defensive.
 Is your manner or approach off-putting?
 Set boundaries & limits. Time to let go?
 Do you wonder about unspoken agendas?
 Sample script
The Argumentative Patient
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Script for argumentative patient
 “You still have pain.”
 “My treatment suggestions do not appear
to be working for you.”
 “You seem more interested in trying these
other therapies.”
 “You can always return.”
The Argumentative Patient
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What’s wrong here
Scenario 4
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What would you do differently?
Scenario 4: The Rescuing – Discouraged Physician
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What do we suggest for the Rescuing Physician?
 What cues your urge to rescue?
 Self-coaching: “What does this patient
really need or want?” “Will I really help this
patient by giving another round of Oxys?”
 Script that is empathic & firm.
The Rescuing – Discouraged Physician
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Script for Rescuing Physician
 “The research & my experience with this
medication tells me that higher levels of
these Oxys are bad for patients. This is
because they lead to complications that are
harmful.”
 “For example, you start to notice that you
have to take increased doses just to get
the same effect. But soon you get less
relief and then more pain.”
 “If these medications allow you to move
more, it makes sense to use them.
Otherwise, we need to find a different
plan.”
The Rescuing – Discouraged Physician
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What do we suggest for discouraged physician?
 Are you aware of feeling discouraged
about this patient?
 Self-coaching: “I’m feeling discouraged
about this patient. How can I proceed in a
more hopeful manner?”
 Sample script
The Rescuing - Discouraged Physician
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Script for Discouraged Physician
 “Although there’s no specific diagnosis, I
do believe that you have real pain.”
 “All the consults and tests support your
experience of chronic pain. And there are
some good ways to manage that pain.”
 “The best pain management will come from
us working together to find the right
combination of pain self-management and
other treatments to support you in this.”
 “For example, I doubt that you will harm
yourself if you do more around the house in
a paced way. And this will help you both
mentally & physically to prepare for work.”
The Rescuing - Discouraged Physician
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Where to learn more
 F. Daniel Duffy et al (2004), “Assessing
competence in communication and
interpersonal skills,” Academic Medicine,
79(6), 495-507.
 Patricia L.B. Lockyear, Dec. 9, 2004,
“Physician-patient communication:
enhancing skills to improve patient
satisfaction.” www.medscape.com
 Peter Tate (2010), The Doctor’s
Communication Handbook, 6th Ed.
Abingdon Oxon, Radcliffe Publishers.
 L. Wen & J. Kosowsky (2012), When
doctors don’t listen. NY: St. Martin’s Press.
Doctor – Patient Communication
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For more information
Practice Support Program
115 - 1665 West Broadway
Vancouver, BC V6J 5A4
Tel: 604 736-5551
www.pspbc.ca
www.pspbc.ca