CEU Series: Conversations Module 9: Talking Medical Procedures

CEU Series: Conversations Module 9: Talking Medical Procedures

CEU Conversations

We Weren't Born as Homeopaths! We came to our profession from many backgroundsCommunication about ourselves and our work is crucialSchool programs have minimal training about thisEffective communication can make or break our practiceWE WANT TO TALK TO CLIENTS IN A WAY THAT

– Provides what clients want and need – Aligns with medicolegal responsibilities – Teams as well as possible with our homeopathic therapeutics

CEU Conversations

We Weren't Born as Homeopaths! We came to our profession from many backgroundsCommunication about ourselves and our work is crucialSchool programs have minimal training about thisEffective communication can make or break our practiceWE WANT TO TALK TO CLIENTS IN A WAY THAT

– Provides what clients want and need – Aligns with medicolegal responsibilities – Teams as well as possible with our homeopathic therapeutics

ConversationsTalking About Medical Procedures

• U Brighton Study: What Clients Want• Medicolegal Guidance – What We Provide• An Opinion is NOT the Same as Assessment/Guidance• Case Examples• Gathering Resources / Preparing for Conversation• Your turn – Questions?

ConversationsTalking About Medical Procedures

• U Brighton Study: What Clients Want• Medicolegal Guidance – What We Provide• An Opinion is NOT the Same as Assessment/Guidance• Case Examples• Gathering Resources / Preparing for Conversation• Your turn – Questions?

U- Brighton Study in 2011:1,649 Osteopathic Patients

U- Brighton Study in 2011:1,649 Osteopathic Patients

U- Brighton Study:What Do Clients Expect / Want

• The study showed clients' expectations – Open minded toward array of therapeutic options– Informed about options– Knowledgable about Referrals

• Clients wanted their practitioner to– Inform them regarding pro / con of option choices– This included options OUTSIDE of osteopathy

• OUR homeopathic clients want this too– Clients have been advised about a procedure– They need to make a decision; ask advice

U- Brighton Study:What Do Clients Expect / Want

• The study showed clients' expectations – Open minded toward array of therapeutic options– Informed about options– Knowledgable about Referrals

• Clients wanted their practitioner to– Inform them regarding pro / con of option choices– This included options OUTSIDE of osteopathy

• OUR homeopathic clients want this too– Clients have been advised about a procedure– They need to make a decision; ask advice

Example: Client Jane Doe

• Jane Doe (72) has been seeing you for 7 months– Client from Eastern Europe; mother had TB after WWII– Client initially reported occasional vertigo rolling over in bed– Chief complaint: R leg foot drop, numbness, stiffness– PLAN: Conium LM1 / 2 / 3– RESPONSE: All symptoms gone; client reports feeling great!

• CALLS after Annual physical / mammogram / lump– Lobular nodule in upper outer quadrant, cherry pit size– Needle biopsy shows stage 1 cancer T1– Client has been advised about mastectomy / lumpectomy– Client has been advised that radiation likely– Client calls you to ask about these approaches, and homeopathy

Example: Client Jane Doe

• Jane Doe (72) has been seeing you for 7 months– Client from Eastern Europe; mother had TB after WWII– Client initially reported occasional vertigo rolling over in bed– Chief complaint: R leg foot drop, numbness, stiffness– PLAN: Conium LM1 / 2 / 3– RESPONSE: All symptoms gone; client reports feeling great!

• CALLS after Annual physical / mammogram / lump– Lobular nodule in upper outer quadrant, cherry pit size– Needle biopsy shows stage 1 cancer T1– Client has been advised about mastectomy / lumpectomy– Client has been advised that radiation likely– Client calls you to ask about these approaches, and homeopathy

Medicolegal Realities:What We Provide

● Overtly state our limitations / scope / position● Remind: I am not a physician. I do not diagnose or treat. ● Emphasize: My professional code of ethics prohibits me from ever

suggesting that anyone stop a therapeutic plan established by your physician. I do not now, nor will I in the future, suggest that you stop or alter any plan you have entered into with your physician.

● State clearly our offering● State: I am able to educate about therapeutic options that may be relevant.● State: I am glad to connect you with resources and information so that

YOU can feel confident about making the right choice for YOU.● State clearly our support as an ally for the client

● State: I hear that this sounds like a very challenging time with you.● State: I am here for you, and we'll work together as you go through this

Medicolegal Realities:What We Provide

● Overtly state our limitations / scope / position● Remind: I am not a physician. I do not diagnose or treat. ● Emphasize: My professional code of ethics prohibits me from ever

suggesting that anyone stop a therapeutic plan established by your physician. I do not now, nor will I in the future, suggest that you stop or alter any plan you have entered into with your physician.

● State clearly our offering● State: I am able to educate about therapeutic options that may be relevant.● State: I am glad to connect you with resources and information so that

YOU can feel confident about making the right choice for YOU.● State clearly our support as an ally for the client

● State: I hear that this sounds like a very challenging time with you.● State: I am here for you, and we'll work together as you go through this

Opinion / My Preference vs Assessment / Guidance

● What is the client really asking? Screen for these● The client is seeking guidance to make his/her best choice● The client may be seeking reassurance● The client may be seeking adjunct care● “How best can I help you in this situation, Jane?”

● What the client is NOT asking – even if it looks like it?● Client may ask: “What would you do, if you were me?”● The client is seeking a solution / reassurance, not your opinion● Response: “What I would do is what I am doing now – helping you to

look at your options. I am glad to talk with you about this. Do you have specific questions about {this procedure / your condition....}

● Response: “My professional code of ethics guides me to keep my personal opinions and professional assessments separate! So let's talk about helping you to find the right choice for you.”

Opinion / My Preference vs Assessment / Guidance

● What is the client really asking? Screen for these● The client is seeking guidance to make his/her best choice● The client may be seeking reassurance● The client may be seeking adjunct care● “How best can I help you in this situation, Jane?”

● What the client is NOT asking – even if it looks like it?● Client may ask: “What would you do, if you were me?”● The client is seeking a solution / reassurance, not your opinion● Response: “What I would do is what I am doing now – helping you to

look at your options. I am glad to talk with you about this. Do you have specific questions about {this procedure / your condition....}

● Response: “My professional code of ethics guides me to keep my personal opinions and professional assessments separate! So let's talk about helping you to find the right choice for you.”

Gathering Resources / Preparing

● So what ARE these procedures??● Diagnostic procedures to diagnose / confirm● Lab tests, MRI, CT scan (with or without contrast)● Exploratory surgery; off label medications ● Travel vaccinations / Booster vaccinations● Elective plastic surgery

● What do I need to know in order to advise?– The process and sequelae of the procedure– Common side effects / what could go wrong– Contraindications– COMPARE THIS WITH YOUR UNDERSTANDING OF CLIENT

Gathering Resources / Preparing

● So what ARE these procedures??● Diagnostic procedures to diagnose / confirm● Lab tests, MRI, CT scan (with or without contrast)● Exploratory surgery; off label medications ● Travel vaccinations / Booster vaccinations● Elective plastic surgery

● What do I need to know in order to advise?– The process and sequelae of the procedure– Common side effects / what could go wrong– Contraindications– COMPARE THIS WITH YOUR UNDERSTANDING OF CLIENT

Gathering Resources / Preparing

● Is this procedure typical for the client/diagnosis/cohort??● For YOUR client – does best practice follow this guideline

● Autoimmune client, advised to take CellCept immunosuppressant ● 85 yo client with history of A-fib, treadmill test suggested● 62 yo client with PSA elevated (5.2) advised to biopsy prostate

● DO you know something about your client that suggests ill effect of procedure?

Gathering Resources / Preparing

● Is this procedure typical for the client/diagnosis/cohort??● For YOUR client – does best practice follow this guideline

● Autoimmune client, advised to take CellCept immunosuppressant ● 85 yo client with history of A-fib, treadmill test suggested● 62 yo client with PSA elevated (5.2) advised to biopsy prostate

● DO you know something about your client that suggests ill effect of procedure?

The Proverbial Case Example...

● Client in 70s with Stage 1 breast cancer● Being advised to consider radiation / chemo● Being advised on advantage of mastectomy vs lumpectomy● “I just don't know what to do!”

● How do we research / advise this client?● How do we stay within ethical guidelines / medicolegal

prudence?● How do we serve the client as an advocate?

The Proverbial Case Example...

● Client in 70s with Stage 1 breast cancer● Being advised to consider radiation / chemo● Being advised on advantage of mastectomy vs lumpectomy● “I just don't know what to do!”

● How do we research / advise this client?● How do we stay within ethical guidelines / medicolegal

prudence?● How do we serve the client as an advocate?

Useful Phrases

● Let's clarify some questions for your practitioner● Exactly what information will you get from this procedure?● Is there a less invasive procedure that can provide same / similar info?● Will the therapeutic plan be the same whether you have this data or not?● What would happen if this procedure is not done?

● Let's get good support for you (client)● Do you have someone who can go with you to your appointments?

Someone who can be a note taker / question asker / listener?● How do you feel about getting a second opinion? Is there a specialty center

available to you, where the latest research and most current best practices are likely to be in place?

● Do you feel comfortable with this doctor, and the level of {proactivity / passivity / aggressive treatments} intervention being advised?

Useful Phrases

● Let's clarify some questions for your practitioner● Exactly what information will you get from this procedure?● Is there a less invasive procedure that can provide same / similar info?● Will the therapeutic plan be the same whether you have this data or not?● What would happen if this procedure is not done?

● Let's get good support for you (client)● Do you have someone who can go with you to your appointments?

Someone who can be a note taker / question asker / listener?● How do you feel about getting a second opinion? Is there a specialty center

available to you, where the latest research and most current best practices are likely to be in place?

● Do you feel comfortable with this doctor, and the level of {proactivity / passivity / aggressive treatments} intervention being advised?

Phrases To Avoid(Just Don't...)

● Well if it were ME, I sure would not do that....● I think your doctor is out of line here...● I would be really scared if I had to do that...● Do you think you could make it through that?● Why would you want to do that?● Well, you probably won't have anything really bad happen...● Well, whatever comes out of it, we can just clean it up later

with homeopathy...● If you do this, then I am not going to work with you any more

– it would be too confusing for your case...

Phrases To Avoid(Just Don't...)

● Well if it were ME, I sure would not do that....● I think your doctor is out of line here...● I would be really scared if I had to do that...● Do you think you could make it through that?● Why would you want to do that?● Well, you probably won't have anything really bad happen...● Well, whatever comes out of it, we can just clean it up later

with homeopathy...● If you do this, then I am not going to work with you any more

– it would be too confusing for your case...

SkillsDevelopment

● Get clear on what clients want ● Read the U-Brighton Study● Consider specific implications for YOUR clients

● Get clear on what your medicolegal obligation ● Professional assessment is not same as opinion● It is not about you or your preference● Education for client, not decision making

● Gather resources to be well informed● Learn about common procedures, risks and benefits– EG. https://www.health.harvard.edu/diagnostic-tests-and-medical-procedures

● Create appropriate documentation for clients

SkillsDevelopment

● Get clear on what clients want ● Read the U-Brighton Study● Consider specific implications for YOUR clients

● Get clear on what your medicolegal obligation ● Professional assessment is not same as opinion● It is not about you or your preference● Education for client, not decision making

● Gather resources to be well informed● Learn about common procedures, risks and benefits– EG. https://www.health.harvard.edu/diagnostic-tests-and-medical-procedures

● Create appropriate documentation for clients

Your Questions?

• Are you ready to swap opinion for assessment?• Know where to research / gather information?• Clear about how to stay within your scope?• Questions?

Your Questions?

• Are you ready to swap opinion for assessment?• Know where to research / gather information?• Clear about how to stay within your scope?• Questions?

CEU Conversations

Verification of TrainingConversations About Medical Procedures

Date:_________ Name:_________________has completed 1 hour of continuing education for

homeopaths in practice and client management.

CEU Conversations

Verification of TrainingConversations About Medical Procedures

Date:_________ Name:_________________has completed 1 hour of continuing education for

homeopaths in practice and client management.