Managing Difficult Conversations

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Managing Difficult Conversations




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Presentations text content in Managing Difficult Conversations

Slide1

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

Slide2

Seven 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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Slide3

Seven 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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Slide4

Seven 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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Slide5

Overlying Principles

There are rules/ givens.You have to listen.

Presented at WSHA Safe Table - ER is for Emergencies

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Slide6

Principles

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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Slide7

Principles

Believe in WIN- WIN.To thine own self be true.Document.

Presented at WSHA Safe Table - ER is for Emergencies

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Slide8

There 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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Slide9

There Are Rules/ Givens

The KeyOwnership

Presented at WSHA Safe Table - ER is for Emergencies

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Slide10

You 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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Slide11

Know 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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Slide12

Know 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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Slide13

Find 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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Slide14

Believe 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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Slide15

Believe In WIN-WIN

ListenRepeat backWork toward a common goalCompromise?

Presented at WSHA Safe Table - ER is for Emergencies

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Slide16

To Thine Own Self Be True

Never LieNever LieNever LIE!

Presented at WSHA Safe Table - ER is for Emergencies

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Slide17

These Are DifficultStressfulConversations!

DebriefAvoid being the one with the disease

Presented at WSHA Safe Table - ER is for Emergencies

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Slide18

Not 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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Slide19

Document

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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Slide20

Someone 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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Slide21

Someone 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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Slide22

Someone 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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Slide23

Someone Is Dying

Don’t lieDon’t steal hopeBe realistic

Presented at WSHA Safe Table - ER is for Emergencies

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Slide24

Someone 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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Slide25

Your 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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Slide26

Bad Outcome

Negative attitude leads to negative outcomes…Blame is for later

Presented at WSHA Safe Table - ER is for Emergencies

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Slide27

Bad 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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Slide28

I 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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Slide29

Drug & 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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Slide30

Drug & 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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Slide31

I Think You’re Here Too Often

PRCPatient’s Requiring Co-ordination

Presented at WSHA Safe Table - ER is for Emergencies

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Slide32

You’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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Slide33

You’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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Slide34

Why 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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Slide35

I 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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Slide36

Difference 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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Slide37

Difference 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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Slide38

That’s Not How Administration Foresees It

Presented at WSHA Safe Table - ER is for Emergencies

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Slide39

Administration’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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Slide40

Administration’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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Slide41

Administration’s Viewpoint

Great leadersget input fromgreat followers

Presented at WSHA Safe Table - ER is for Emergencies

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Slide42

Managing 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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