managing difficult conversations social psychology 201 for ed’s stephen h. anderson m.d., facep...
TRANSCRIPT
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Managing Difficult ConversationsSocial Psychology 201
For ED’s
Stephen H. Anderson M.D., FACEPPresident, WA State Chapter ACEP
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Seven Conversations
• Grieving
• 1) Someone is dying/ died.
• 2) Your child is going to have a bad
outcome.
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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?
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Seven Conversations
• Colleague/ Political
• 6) I disagree with you as a colleague.
• 7) That’s not how administration
foresees it.
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Overlying Principles
•There are rules/ givens.
•You have to listen.
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Principles
• Know your allies…
• Know their allies.
• Find your support…
• Find their support.
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Principles
•Believe in WIN- WIN.
•To thine own self be true.
•Document.
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There Are Rules/ Givens• Some are hard…
• Some are soft.
• Some are “ours”…
• Some are “only mine”.
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There Are Rules/ GivensThe Key
Ownership
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You Have To Listen• Conversations are two way.
• Find out their goals.
• Find out their fears.
Give them enough rope…
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Know Your Allies…
• Rally your troops.
• Build your allies.Do you want to be an expert witness?
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Know Their Allies…
• Introductions for EVERYONE.
• Note “Alleged Allies” not
present
Acknowledge as appropriate.
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Find Your Support
Find Their Support
• Key to the Grieving Conversation
• If you’re headed to war…
take them with you.
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Believe In WIN-WIN
• Try never to define your
win, by their loss.
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Believe In WIN-WIN• Listen
• Repeat back
• Work toward a common goal
• Compromise?
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To Thine Own Self Be True
• Never Lie
• Never Lie
•Never LIE!
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These Are DifficultStressful
Conversations!
• Debrief
• Avoid being the one with the
disease
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Not All Conversations
Will End WIN-WIN
• Some won’t end.
• Have an exit strategy.
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Document• ANY conversation with “potential” is
worth documenting.
• Two documented views are better
then one.
• “They” know how to document too!
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Someone Is Dying/ Died
• It’s someone’s job,
take ownership.
• Find your support
• Find their support
#1Most
Important
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Someone Died
• Focus on the closest,
talk to everyone
• Listen
• Account for beliefs/ cultures
• Physical contact, the “healing
touch”.
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Someone DiedGoals To Express
• 1) We did everything appropriate.
• 2) Address pain & suffering.
• 3) “Now we are here to help you…
& others.”
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Someone Is Dying
Don’t lie
Don’t steal hope
Be realistic
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Someone Is Dying
Listen ( Is the PATIENT speaking through an advanced directive?)
Find your support/ Find their
support
Start the conversation
Geography/ proximity
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Your Child Is Going To Have A Bad Outcome
• Find your support/ Find their support
• Don’t steal hope
• Be honest “in that moment”
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Bad OutcomeNegative attitude leads to
negative outcomes…
Blame is for later
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Bad Outcome
•Child’s safety first
•When do you include the
child in the conversation?
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I Think You Have A Drug/ Alcohol
ProblemSociety/ Legislature/ Peers now tell us
We MUST have these conversations
THIS is the pivotal time.
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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
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Drug & AlcoholTools to Help
• Old Records
• EDIE
• WA state Prescription Monitoring Program
Educate patients that these exist
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I Think You’re Here Too Often
PRCPatient’s
Requiring
Co-ordination
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You’re Here Too OftenNew 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
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You’re Here Too Often
“You’re Unique, but…”
Educate
“The Econ Lecture”
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Why Are You REALLY Here?
• Constructively focuses the scatter.
• Gives an opening to the REAL difficult
conversation.
NEVER demean the answer
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I Disagree With YouAs A Colleague
Fatal Error VS. Difference Of Opinion
Fatal Error
Success comes through education first
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Difference of Opinion
With A ColleaguePraise 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
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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.
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That’s Not How Administration
Foresees It
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Administration’s ViewpointThe 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.
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Administration’s Viewpoint
What brought you to the table?
1)What do they need from you?
2)What motivates you?
Principles
Priorities
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Administration’s Viewpoint
Great leaders
get input from
great followers
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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