Transcript Communicating with Pain Patients *OPTIONAL

Pain Management
Communicating with Chronic Pain Patients
Learning Session 1
Drs. Wesley Buch & David Hunt
Presenter’s name here
Location here
Date here
www.pspbc.ca
Faculty/Presenter Disclosure
Speaker’s Name: Speaker’s Name
Relationships with commercial interests:
- Grants/Research Support: PharmaCorp ABC
- Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
- Consulting Fees: MedX Group Inc.
- Other: Employee of XYZ Hospital Group
2
Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [describe support here – e.g. educational grant].
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support].
Potential for conflict(s) of interest:
- [Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose product(s) are
being discussed in this program].
- [Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program: [enter generic
and brand name here].
3
Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
4
Certification
 Up to 21 Mainpro+ Certified credits for GPs awarded upon
completion of:
› All 3 Learning Sessions (NOTE: Credits and payment will be based on
the exact number of hours in session)
› At least 1 Action Period
› The Post-Activity Reflective Questionnaire (2 months after LS3)
 Up to 10.5 Section 1 credits for Specialists
› All 3 Learning Sessions (NOTE: Credits and payment will be based on
the exact number of hours in session)
› The Post-Activity Reflective Questionnaire (2 months after LS3)
5
Update/revise
Action Plan
Report of AP1
experiences &
successes
Payment for:
PMV (optional)
LS1
Action Period 1
6
Refine
implementation;
embed & sustain
improvements
attempted in
practice via
Action Plan +
AP2
requirements
Interactive
group learning
Finalize Action
Plan
Report of AP2
experiences &
successes
Payment for:
LS2
Action Period 2
LS3
Reflection
Interactive
group learning
Learning Session 3
Create Action
Plan (using
template)
Planning & initial
implementation
in practice;
review of Action
Plan &
improvements
attempted in
practice + AP1
requirements
Action Period 2
Interactive
group learning
Learning Session 2
Opportunity
for in-practice
visit to
introduce
applicable
EMR-enabled
tools &
templates prior
to LS1
Action Period 1
Learning Session 1
Pre-Module Visit
Learning Session & Action Period Workflow
Reinforce &
validate practice
improvements
GPs & Specialists
complete PostActivity
Reflective
Questionnaire
(PARQ) 2 months
after LS3 &
submit to PSP
Central
Payment Stream 1 (ideal)
Current Rates:
GPs
Specialists
MOAs
Hourly Rate
$125.73
$148.31
$20.00
Action Period 1
$880.10
$1,038.16
N/A
Action Period 2
$660.07
$778.62
N/A
Payment made after attending LS2
Payment made after attending LS3
GPs:
GPs:
PMV
= $125.73
LS2
= $440.05 ($125.73 x 3.5hrs max.)
LS1
= $440.05 ($125.73 x 3.5hrs max.)
AP2
= $660.08
AP1
= $880.10
LS3
= $440.05 ($125.73 x 3.5hrs max.)
TOTAL
$1,445.88
TOTAL
Specialists
Specialists
LS1
= $519.08 ($148.31 x 3.5hrs max.)
LS2
= $519.08 ($148.31 x 3.5hrs max.)
AP1
= $1,038.16
AP2
= $778.62
$1,557.24
LS3
= $519.08 ($148.31 x 3.5hrs max.)
TOTAL
TOTAL
MOAs
$1,816.78
MOAs
PMV
= $20.00
LS1
= $80.00 ($20.00 x 4hrs max.)
LS2
= $80.00 ($20.00 x 4hrs max.)
$100.00
LS3
= $80.00 ($20.00 x 4hrs max.)
TOTAL
TOTAL
7
$1,540.18
$160.00
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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