when providers & patients disagree: moving from conflict to collaboration
DESCRIPTION
Session # B5b October 29, 2011 1:30 P M. When Providers & Patients Disagree: Moving From Conflict to Collaboration. Steve Simms, Ph.D. Philadelphia Child & Family Therapy Training Center George F. Blackall, Psy.D ., MBA Penn State College of Medicine. - PowerPoint PPT PresentationTRANSCRIPT
When Providers & Patients Disagree: Moving From Conflict to
Collaboration
Steve Simms, Ph.D.Philadelphia Child & Family Therapy Training Center
George F. Blackall, Psy.D., MBAPenn State College of Medicine
Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Session # B5bOctober 29, 20111:30 PM
Faculty Disclosure
• I/We currently have or have had the following relevant financial relationships (in any amount) during the past 12
months:
• Royalties from the ACP Press for:• Breaking the Cycle: How to Turn Conflict into Collaboration
When You and Your Patients Disagree
Need/Practice Gap & Supporting Resources
What is the scientific basis for this talk?
The scientific basis for this talk will be presented in our first nine slides
ObjectivesShould tie the Needs and Outcomes together
• Describe how a systems approach to clinical conflicts can help a provider to see, understand, and ultimately resolve an impasse.
• Be able to identify which model of practice (Physician-as-Expert or Physician-as-Collaborator) to apply in conflicted clinical scenarios.
• Apply the model of the symptomatic cycle to the presented case scenario.
• Be able to apply the Five Universal Principles for a Collaborative Doctor-Patient Relationship to conflicts with patients.
Expected Outcome
Healthcare providers will be able to see, understand, and respond to impasses with patients and family members using
the models presented in this workshop.
The State of the Union
What percentage of patient visits do PCP’s classify as “difficult”?
A. 5B. 17C. 9D. 21
An, et. al. JAMA, 2009
The State of the Union
How long do MD’s allow their patients to speak uninterrupted?
A. 1 minuteB. 2 minutesC. 90 secondsD. 23 seconds
• Beckman & Frankel, An Intern Med, 1984• Marvel et. al. JAMA, 1999
The State of the Union
On average, when not interrupted, how long will patients spend presenting an initial concern to their MD?
A. 4 minutesB. 120 secondsC. 90 secondsD. 5 minutes
Langewitz et. al. BMJ, 2002
The State of the Union
Patients can tell when their doctor does not like them.
True
False
Levinson et. al. Pt Educ & Counseling, 2006
State of the Union
• What percentage of patients who recognize their terminal illness prefer symptom-directed care over life-extending care?
A. 27B. 54C. 83D. 16
Mack et. al., 2010
State of the Union
The # 1 thing dying patients want from their physician’s communication with them is:
A. protect family members from the reality of the prognosis.B. talk with them in an honest and straightforward way.C. not take away hope.D. provide hope at all costs.
• Wenrich, et. al. 2001
State of the Union
• When cancer patients expressed negative emotions to their oncologist, the oncologists’ responded empathically in what percentage of interactions?
A. 90B. 50C. 75D. 35
Kennifer et. al., 2009
State of the Union
• An empathic response to a patient’s expression of negative emotion, on average, lengthens visits by how long?
A. 5 minutesB. 10 minutesC. 3 minutesD. None of the above
• Kennifer et.al. 2009
State of the Union
21 Seconds!
Case #1
23 yo female recently diagnosed with recurrent and metastatic sarcoma. The diagnosis is terminal.
Original diagnosis 2 years earlier resulted in surgical removal of a sarcoma from her left thigh.
Patient was well until one month ago when she started experiencing night sweats and difficulty breathing.
Patient was about to graduate from college when symptoms appeared.
Patient is currently in the ICU and according to staff is uncooperative and making suicidal statements.
Case #1
Social background: Patient was adopted and has a 14 yo adoptive brother.
Family is intact and high functioning.No history of mental illness.
Case #1
Pt. has been “uncooperative” with staff.Pt. has asked nurses and residents things
like: – “How many of these pills do I have to take to
kill myself?”– “Can you give me enough medicine to end
this?”– “What’s the quickest way to die?”
Case #1
When the chief resident goes into the pt’s room, she motions for him to sit down.
As he leans toward her she says:“Will you please shoot me tonight?”
THE SYMPTOMATIC CYCLE
• “Symptoms in families evolve in a context of interpersonal isolation, characterized by conditional acceptance and efforts to control one another”.
» Micucci, 1998, p. 17
THE SYMPTOMATIC CYCLE
SYMPTOM ARISES
FAMILY & STAFF FOCUS ON ELIMINATING SX
RELATIONSHIPS PT SEEN AS NEGLECTED THE
PROBLEM
RELATIONSHIPS PT FEELS DETERIORATE MISUNDERSTOOD
SYMPTOM INTENSIFIES
(Micucci, 1998, p.18)
Five Universal Principles for Collaborative Patient Relationships
• Competence: All patients and families bring a pre-existing set of competencies to the illness experience.
• Connection: Isolation and disconnection from important relationships breeds conflict and leads to psychological distress.
• Control: Control is a Myth• Contribution: Your blind spots fuel impasses• Collaboration: The above principles apply to staff as well
as patients and families. Blackall, Simms & Green (2009)
ARCH An Impasse Prevention Tool
• Acceptance
• Respect
• Curiosity
• Honesty• Micucci, 1998
WHAT YOU CAN DO
• Know your role, limits and function.• Know the role and function of all the
people connected to the impasse.• Decrease your own isolation.• Focus on relationships.
FOCUS ON RELATIONSHIPS
• Tolerate the intensity of emotions around the dilemma.
• Highlight competencies.• Keep the conversation going.• People find common ground when they feel
heard and understood.
Take Home Message
• Highlight Competencies• Focus on Relationships• Decrease Isolation• Keep the Conversation Going
Session Evaluation
Please complete and return theevaluation form to the classroom monitor
before leaving this session.
Thank you!