Presentations text content in Managing Difficult Conversations
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Managing Difficult Conversations
Social Psychology 201for ED’s
Stephen H. Anderson M.D., FACEPPresident, WA State Chapter ACEP
Presented at WSHA Safe Table - ER is for Emergencies
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September 24, 2012
Slide2Seven Conversations
Grieving1) Someone is dying/ died.2) Your child is going to have a bad outcome.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide3Seven Conversations
Sheriff/ Parenting3) I think you have a drug/ alcohol problem.4) I think you’re here too often.5) Why are you REALLY here?
Presented at WSHA Safe Table - ER is for Emergencies
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Slide4Seven Conversations
Colleague/ Political6) I disagree with you as a colleague.7) That’s not how administration foresees it.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide5Overlying Principles
There are rules/ givens.You have to listen.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide6Principles
Know your allies…Know their allies.Find your support…Find their support.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide7Principles
Believe in WIN- WIN.To thine own self be true.Document.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide8There Are Rules/ Givens
Some are hard…Some are soft. Some are “ours”… Some are “only mine”.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide9There Are Rules/ Givens
The KeyOwnership
Presented at WSHA Safe Table - ER is for Emergencies
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Slide10You Have To Listen
Conversations are two way.Find out their goals. Find out their fears.Give them enough rope…
Presented at WSHA Safe Table - ER is for Emergencies
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Slide11Know Your Allies…
Rally your troops.Build your allies.Do you want to be an expert witness?
Presented at WSHA Safe Table - ER is for Emergencies
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Slide12Know Their Allies…
Introductions for EVERYONE.Note “Alleged Allies” not present Acknowledge as appropriate.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide13Find Your SupportFind Their Support
Key to the Grieving ConversationIf you’re headed to war… take them with you.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide14Believe In WIN-WIN
Try never to define your win, by their loss.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide15Believe In WIN-WIN
ListenRepeat backWork toward a common goalCompromise?
Presented at WSHA Safe Table - ER is for Emergencies
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Slide16To Thine Own Self Be True
Never LieNever LieNever LIE!
Presented at WSHA Safe Table - ER is for Emergencies
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Slide17These Are DifficultStressfulConversations!
DebriefAvoid being the one with the disease
Presented at WSHA Safe Table - ER is for Emergencies
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Slide18Not All ConversationsWill End WIN-WIN
Some won’t end.Have an exit strategy.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide19Document
ANY conversation with “potential” is worth documenting.Two documented views are better then one.“They” know how to document too!
Presented at WSHA Safe Table - ER is for Emergencies
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Slide20Someone Is Dying/ Died
It’s someone’s job, take ownership.Find your supportFind their support
#1MostImportant
Presented at WSHA Safe Table - ER is for Emergencies
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Slide21Someone Died
Focus on the closest, talk to everyoneListenAccount for beliefs/ culturesPhysical contact, the “healing touch”.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide22Someone DiedGoals To Express
1) We did everything appropriate.2) Address pain & suffering.3) “Now we are here to help you… & others.”
Presented at WSHA Safe Table - ER is for Emergencies
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Slide23Someone Is Dying
Don’t lieDon’t steal hopeBe realistic
Presented at WSHA Safe Table - ER is for Emergencies
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Slide24Someone Is Dying
Listen ( Is the PATIENT speaking through an advanced directive?)Find your support/ Find their supportStart the conversationGeography/ proximity
Presented at WSHA Safe Table - ER is for Emergencies
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Slide25Your Child Is Going To Have A Bad Outcome
Find your support/ Find their supportDon’t steal hopeBe honest “in that moment”
Presented at WSHA Safe Table - ER is for Emergencies
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Slide26Bad Outcome
Negative attitude leads to negative outcomes…Blame is for later
Presented at WSHA Safe Table - ER is for Emergencies
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Slide27Bad Outcome
Child’s safety firstWhen do you include the child in the conversation?
Presented at WSHA Safe Table - ER is for Emergencies
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Slide28I Think You Have A Drug/ Alcohol Problem
Society/ Legislature/ Peers now tell us We MUST have these conversationsTHIS is the pivotal time.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide29Drug & Alcohol ProblemsThe Principles
There are rules/ guidelinesListen firstYour allies/ their allies “Their support” might turn out to be your best ally!”WIN-WINBe true to yourself
Presented at WSHA Safe Table - ER is for Emergencies
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Slide30Drug & AlcoholTools to Help
Old RecordsEDIEWA state Prescription Monitoring Program Educate patients that these exist
Presented at WSHA Safe Table - ER is for Emergencies
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Slide31I Think You’re Here Too Often
PRCPatient’s Requiring Co-ordination
Presented at WSHA Safe Table - ER is for Emergencies
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Slide32You’re Here Too OftenNew WA Hospital Requirements
Identify PRC clients upfrontNotify their PCP of visitDischarge patient with instructions along:“the right patient-to the right place-at the right time”Shouldn’t be a punitive discussion
Presented at WSHA Safe Table - ER is for Emergencies
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Slide33You’re Here Too Often
“You’re Unique, but…”Educate“The Econ Lecture”
Presented at WSHA Safe Table - ER is for Emergencies
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Slide34Why Are You REALLY Here?
Constructively focuses the scatter.Gives an opening to the REAL difficult conversation.NEVER demean the answer
Presented at WSHA Safe Table - ER is for Emergencies
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Slide35I Disagree With YouAs A Colleague
Fatal Error VS. Difference Of OpinionFatal ErrorSuccess comes through education first
Presented at WSHA Safe Table - ER is for Emergencies
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Slide36Difference of Opinion With A Colleague
Praise in Public/ Debate in PrivateAsk yourself going in:What’s my goal?Am I a team builder?How can I make this WIN-WIN?Focus on the patient
Presented at WSHA Safe Table - ER is for Emergencies
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Slide37Difference Of Opinion With A Colleague
ListenAgree on the easy, Work toward the hard.Set the stage for “The Next Time”If necessary, use the chain of command.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide38That’s Not How Administration Foresees It
Presented at WSHA Safe Table - ER is for Emergencies
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Slide39Administration’s Viewpoint
The Golden RuleDo unto others, as you would have others do unto you.Those with the gold, make the rules.Every pathway has an economic angle.
Presented at WSHA Safe Table - ER is for Emergencies
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Slide40Administration’s Viewpoint
What brought you to the table?What do they need from you?What motivates you?PrinciplesPriorities
Presented at WSHA Safe Table - ER is for Emergencies
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Slide41Administration’s Viewpoint
Great leadersget input fromgreat followers
Presented at WSHA Safe Table - ER is for Emergencies
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Slide42Managing Difficult Conversations
There are rules/ givensYou have to listenKnow your allies/ know their allies Find your support/ find their supportBelieve in WIN-WINTo thine own self be trueDocument
Presented at WSHA Safe Table - ER is for Emergencies
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Managing Difficult Conversations
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