Arora Medical Education PLAB 2 Communication Course Slides PDF

PLAB 2 Consultation Skills Course!
With Aspire Academy
Dr. Aman Arora

aroraMedicalEducation

2018
The plan

o  Basic principles – what is key with consultation and communication?
o  Role-Play sessions
o  Regular breaks including lunch
o  Relaxed but focused
o  Informal – ask any questions
o  Safe environment
Copyright Arora Medical Education Ltd Not to be used for medical advice
Your needs…
My aims…
o  Understand
o  Exposure
o  Confidence
Note….
Dr. Aman Arora is an ex GMC PLAB 2 examiner.

He can not therefore discuss any previous GMC
exam cases or any GMC training material.
You know how to communicate already!
ü  You’ve seen enough
patients in your life
ü  You know how to

talk to them
ü  Being natural and

trusting instincts is
important
Copyright Arora Medical Education Ltd

General Consultation Themes
o  First half
o  What are the ISSUES?
o  Red flags
o  Psychosocial
o  ICE

o  Second half
o  How quick can I show the examiner that I
understand and manage the important
issues?
o  How quick can I bring back and discuss
the issues with the patient?
o  Good communication needs to be

throughout both
General Communication Themes
o  2-way conversation
o  ‘Chuck and check’
o  Open and closed questions
o  Patient-centred
o  “How does that sound?”
o  “Am I making sense to you?”
o  “Let me know if I’m going too fast”
o  Acknowledge everything
o  Cues (verbal and non-verbal)
o  Emotion
o  Fears
General Communication Themes
o  Rapport
o  Reflect eg in ICE
o  Relevance eg in psychosocial
o  Body language
o  Open/closed
o  Empathise / sympathise
appropriately
o  “I understand how you feel”
o  “I can see how this is difficult for you”
Scenario 1
Mr. Geoff Roberts
34 year old male

You have been asked to see Geoff Roberts - a patient on the ward
who is being treated with IV antibiotics for cellulitis of his leg.

Clinically his leg has been improving and is due to be discharged in
two days. His last observations have been normal and the cellulitis
area has been reducing.

There has been an emergency on the ward which has led to a 1
hour delay in his medication being given.

1. The Angry Patient
o  Challenges
o  The patient overtakes the conversation
o  The patient doesn’t calm down at all
o  Can’t cover practical needs such as
discussing the medication as anger
dominates
o  Our own tension/nerves increase
o  Doctor gets frustrated and annoyed
o  Key end points

o  Patient’s anger is managed
o  Patient’s medication is given

1. Possible Strategies

o  Eye level
o  Stand or sit to match eye level
o  Aim for sitting down eventually
o  Distance
o  Watch for role-player gradually closing distance
o  Look out for your own subconscious leaning in
o  Regular reflection of anger

o  “I can see that this is frustrating you”
o  “I can clearly see that you are annoyed”
o  Try not to make excuses/defend actions

o  “It wasn’t our fault…the other patient was unwell”
o  “There are other patients who are also important”
o  Acknowledge their importance

o  “You are right – your medication is important”
o  “Correct – getting medication in time is important”

o  Focus back to the resolution
o  “Lets see how we can resolve this”
o  “My focus is your needs – I’ll make sure you get your medication right away”

Scenario 2
Mr John Walsh
56 year old male

You have been given a chest x-ray report for a John Walsh, who
was admitted with a 6 month history of worsening cough.

It shows a mass in the right upper lobe and suggests a strong
likelihood of lung cancer. Follow-up CT has shown likely
metastases.

You have been asked by your consultant to explain the results.

2. Breaking Bad News
o  Challenges
o  Balance between medical information
and dealing with reaction
o  Often many questions have no
answers at present
o  How much information to ask at this
stage
o  Key end points

o  All immediate concerns dealt with
o  Patient knows plan going forward
o  Balance between giving the information quickly but
sensitively (buffer)
o  “Best case scenario…worst case scenario”
o  Expect and allow for reaction

o  “I can see that this is a lot to take in”
o  “Take your time…there’s no rush”
o  Think support systems

o  “Is there anyone with you today?”
o  “Is there anyone else who you would like me to talk to?”
o  Don’t commit to answers if you don’t know

o  “I can understand this information will cause a lot of queries in your
mind – unfortunately I don’t have all the answers at present”
o  Leave a method for ongoing communication afterwards

o  “Don’t hesitate to ask if you have any queries after this”
o  “I’m sure many more questions will come to your mind”

Scenario 3
Mr Rajeev Singh
49 year old male

Mr Singh has been admitted with a provisional
diagnosis of temporal arteritis and has been
commenced on oral prednisolone.

He is refusing to take the prednisolone.

3. The Patient Who Refuses Treatment
o  Challenges
o Medical need vs patient’s personal
fear
o  Key end points

o Patient is competent to make a
decision
o Ideally patient accepts treatment
o Their concerns are fully addressed
o  Acknowledge their right to be involved in their own treatment early on
o  Why are they refusing?

o  “Do you mind telling me why you don’t want the treatment?”
o  “Does the medication concern you in any way?”
o  Acknowledge their situation

o  “I can see that your sport is very important to you”
o  “The last thing we want is to affect your diving”
o  Clearly communicate ultimate risk

o  “The reason that we usually give steroids in this situation is…”
o  Offer solutions
o  “How about I look into the rules for you?”
o  “Maybe there are specific rules/allowances for these medications – lets look
into it”
o  “Is there anyone that you know who might have a little more knowledge
about this?”
o  Remember you may not be able to convince someone – what is next best?
o  Medication refusal in general

o  Fear of side-effects
o  Past negative experience
o  Fear of effect on job eg hypoglycaemic events
o  Fear of addiction/tolerance
Scenario 4
Richard Weaver
65 year old male

Mr Weaver has had a myocardial infarction last week.
He has recovered well, has been started on relevant
medications and is due for discharge tomorrow.

You have been asked to carry out a diet history and
counsel him appropriately.

4. Health Promotion - Diet Counseling
o  Challenges
o Different approaches
o Don’t want to lecture
o  Key end points

o Patient understands key
diet advice
o  Carrot vs stick approach
o  “There are many benefits that you may find through changing diet such as
your cholesterol being reduced”
o  “If you continue with this diet unfortunately your blood pressure might
continue to rise”
o  Acknowledge potential barriers

o  “I can understand it is difficult to achieve a balanced diet with modern-day
challenges”
o  “You mention the canteen serves unhealthy food - how about considering
packed lunches?”
o  “Habits are difficult to change sometimes – small but regular changes that
don’t impact your lifestyle are often easier than big changes that don’t last”

o  Who can help at home?
o  “You mentioned your wife – could family get involved with this?”
o  Explain risks clearly in relation to his MI
o  Offer support – dietician/leaflets etc

o  “Is there any other way that we can support you?”
o  “Sometimes talking to others can help”
o  Key pointers:
o  White meat instead of red meat
o  Grilled instead of fried
o  Olive/rapeseed oil instead of butter
o  5 fruits/vegetables a day
o  Reduce salt (6g per day) and sugar
Scenario 5
Mr Majeed Qureshi
68 year old male

A lady has demanded to see a doctor on the
ward of her father, Mr Majeed Qureshi.

Her father was admitted 3 days ago with a hip
fracture but has suffered a stroke overnight. He
had all the appropriate preventative measures in
place.

5. Angry Relative
o  Challenges
o Anger can dominate
the situation
o Natural when family
members are involved
o  Key end points

o Pacify the situation
o Solution that everyone
is happy with
o  Acknowledge their anger
o  “I can clearly see that you are angry”
o  “You’re frustration is understandable”
o  Confidentiality
o  “I know it is frustrating but I do need to check that we
have permission to discuss your father’s medical records”
o  Empathise with their situation

o  “Hearing that your father has had a stroke is a big thing”
o  Offer to investigate
o  “Would you mind if I looked into the situation a little further
– I think some details need to be clarified”
o  Explain ’Duty to every patient’

o  “It is very important to us that we minimise harm and
suffering for our patients”

o  Complaints procedure
o  “I ensure you we will look into this fully but if you wished
to take this further then I can explain the procedure to you
full”
Scenario 6
Mrs Jane Donovan
26 year old female

Jane Donavan presents with a broken wrist
which has been put in a cast. She stated to
nursing staff that she had slipped on the ice.
She has been cleared to go home.

She has asked to speak with the doctor in the

Accident & Emergency department.

6. Domestic Violence
o  Challenges
o Patient often doesn’t want help
o Children involved
o  Key end points

o Patient safety
o Aware of options/help
o  Look for cues if patient not initially open
o  “He’s this, I’m that”
o  Be clear and consistent

o  “This is illegal”
o  “You don’t need to put up with this”
o  “This is not your fault”
o  “Please don’t blame yourself”
o  Offer support
o  “We can help in any way you think we can”
o  “Have you considered approaching the police?”
o  “We can contact relevant people for you if this is easier”
o  Ask about children

o  “Has he ever hit the children?”
o  “Are there any children in the house?”

Scenario 7
Mr Jack Hobbs
23 year old male

Jack has recently been diagnosed with
chlamidiya through a urine test after requesting a
test himself. He has had the approproate
treatment.

Your consultant asks you to carry out a sexual

history.

7. Sexual History Taking
o  Key end points

o Aim to take full history with
patient at ease
o  Challenges
o Doctor embarrassment
o Patient embarrassment

o  Signpost right at the beginning
o  “throughout the consultation I may be asking you a few personal questions”
o  Signpost everything well

o  “I’d like to ask a few symptoms that can present with infections down below – is that
ok?”
o  “I’d like to ask a few questions about your partner history if ok with you – these can
be important in these sitautions”
o  Embarrassment
o  Acknowledge
o  “I can see that you are a little embarrased”
o  “We see this type of thing almost daily as doctors”
o  “Your symptoms are actually very common”
o  Importance of time…“There is no rush – please take your time”
o  Thank them for coming…“Thank you for coming to the hospital to discuss this – I
know it can’t have been easy”
o  Reassure about common nature of problem… “What you are talking about is
something that is very common – you are certainly not alone”
o  Offer relevant alternatives…“If you prefer I could ask if a female doctor see you”
o  Remember about confidentiality

o  “If it makes it any easier remember that anything you say is confidential unless safety
issues for you or others arise”

o  Offer an alternative
o  “I can see you are uncomfortable - would you prefer to see a female/male doctor?”

Scenario 8
Mr Wayne Pollock
2 year old male

Wayne is brought in by his parents with a
spiral fracture to his femur. He has been
stabilised and treated appropriately.

You have been asked to carry out a history as
from mum to find out what happened.

8. Non-Accidental Injury
o  Challenges
o Easy to sound accusatory
o Parent reaction
o  Key end points

o Patient safety
o Parents happy with plan if
possible
o  Non-accusatory questioning
o  “Could you take me through what happened?”
o  “We’re just trying to put together the story”
o  “No-one is blaming anyone here”
o  Honesty but clarity

o  “I’m a little concerned that the story doesn’t seem to match up”
o  “This type of injury doesn’t usually happen with the story that you
describe”
o  “Our number one concern has to be the child”
o  “Mrs. X I’m actually a little worried about what we’ve seen and heard
with regards to this injury…I think this needs a slightly larger
assessment by someone with a lot more experience that us in this
area…”
o  ‘Buffer’ social services / child safeguarding etc
o  Predict “they’ll take my children away!”

o  “The number one aim would be to keep the children with you – its just
that the environment needs to be safe first”
o  Encourage mum to be on your side if at all possible first
o  If not however, need to be firm

o  “Unfortunately given what has happened it is not something that I can
let go”

Scenario 9
Mr Adedeyo Odibe
32 year old male

You are asked by your consultant to discuss diabetes
treatment with Mr. Odibe who has a long history of very
poorly-controlled diabetes.

He has been admitted with a 3rd episode of DKA and is
now fit for discharge.

His medication (not changed since admission) includes
insulin and two oral hypoglycaemics.

9. The Blaze Patient
o  Challenges
o Very frustrating scenarios
o  Key end points

o Patient is on your side, engaging
o Consultation ends with patient
opposite to how they walked in
9. Possible strategies
o  Acknowledge they don’t want to be there
o  “I can see that you don’t seem to want to discuss your
diabetes today”
o  “I can appreciate that there are many other things that you
would rather be doing than discussing your diabetes”
o  “Is there any way that you would like us to address your
diabetes?”
o  Back to basics – ICE

o  “Why do you think your diabetes is uncontrolled?”
o  “You don’t seem to be too concerned by what we’ve told you
about your diabetes….Is there anything that worries you
about your diabetes?”
o  “I know you didn’t really want to be here, but now that you
are here, is there anything that you think I can do?”
o  Targeted second half to consultation

o  “I know you mentioned you were worried about your kidneys
– why don’t we see what we can do to save those”
o  “Let’s try and look at your weight/exercise/medication to help
save your kidneys”
o  “If we don’t tackle your diabetes, we may well end up losing
your kidneys”
Scenario 10
Mr Jason Fritz
15 year old male

Jason is consenting to have an incarcerated
hernia repaired.

Your consultant has asked to assess his

capacity to make the decision.

10. Consent / Capacity
o  Challenges
o How to judge if components are
covered
o Gillick vs Fraser competence
o  Key end points

o Is patient competent?
o  At 16 presumed competent to make decisions
o  Gillick competence
o  Under age 16 are they able to demonstrate capacity?
o  Fraser competence
o  Specifically for contraception consent
o  Components of capacity
o  Can they understand the information?
o  Can they retain the information?
o  Can they weigh up the information?
o  Can they communicate the decision?
o  Example questions
o  “Can you tell me what you understand from what we have discussed?”
o  “I’ve mentioned a lot there – could you repeat what I’ve talked about so
I know I haven’t confused things?”
o  “Are you able to tell me what is running through your mind?”
o  “Are you able to tell me what you have decided?”
Scenario 11
Mrs Edith Francis
76 year old female

You have been asked to speak to the daughter
of Mre. Francis - a lady with terminal breast
cancer.

She has two weeks to live and her daughter is
concerned about her symptoms.

11. Palliative Care

o  Challenges
o  Confidentiality issues
o  Limited answers to challenging
questions
o  Dealing with impact on the daughter
as well as patient issues
o  Key end points

o  Daughter’s concerns acknowledged
o  Key palliative care concepts covered
o  Acknowledge 3 aspects of Palliative Care
o  Physical – symptoms eg pain
o  Emotional – depression, anxiety, fear
o  Practical – support systems
o  Giving time is paramount

o  “Please take your time….no rush”
o  “You are our main priority right now”
o  Don’t assume what their main concerns are

o  “Tell me what matters to you and your mother right now”

o  Empathise regularly
o  “I can see that this must be really difficult both for you and for your mother”
o  “Seeing family members in this situation can be a real challenge”
o  Who else can be involved?

o  “Please don’t ever feel alone in all of this”
o  Family
o  Support groups / organisations
o  “There are many ways that we can support you and your mother”

Scenario 12
Mrs Jennifer Capris
43 year old female

Mrs. Capris has been admitted with problem-drinking
and has had some haematemesis overnight.

She has attended several times with this problem and
has been advised that she needs an OGD tomorrow.

She wishes to self-discharge this morning.

12. The Patient Who Wants !
To Leave Hospital
o  Challenges
o Frustration if can’t persuade them
o  Key end points

o Patient makes a competent
decision
o Ultimate risk is understood
o  Are they competent to make this decision?
o  Can they understand the information?
o  Can they retain the information?
o  Can they weigh up the information?
o  Can they communicate their decision?
o  What are the reasons for leaving hospital?

o  Job / Financial / Family / Fear / Previous experience / Holiday booked / Pet at home etc
o  “Is there anything in particular that is stopping you from staying in hospital?”
o  “Is there any way that I can help with your job/family/fear etc?”
o  Acknowledge their situation

o  “No-one wants to be in hospital”
o  “I can see that it is a big inconvenience for you”
o  Do they understand ultimate risk?

o  “I don’t wish to worry you too much but the reason we wish to keep you in hospital and treat this, is that if this condition
gets worse, potentially it can be life-threatening”

o  Who else can you get involved?
o  “Is there anyone else that you wish to discuss things with – maybe they can help with your…?”
o  If competent and still wishes to go, what is the next best way that you can help?
o  “Ok I can see that you still wish to go – could we at least put in an alternative plan as I’m still worried
about you?”
o  Review the next day?
o  Urgent clinic appointment
o  Contact numbers

Scenario 13
Miss Francis Jones
33 year old female

Miss Jones is known to have a long history of
migraines and is seen regularly by the neurologists.
She had a normal CT scan 3 months ago.

She has attended A&E with another migraine and the
pain has now settled with treatment. She is fit to be
discharged but asks to see a doctor.

13. The Demanding Patient
o  Challenges
o Easy to get into an argument
o Easy to give your answer too
early
o  Key end points

o Patient agrees to reduce
demand
o Resources appropriately used
o  Regularly acknowledge the demand
o  “I know you really want the scan – I promise I’ll come on to that shortly”
o  “I know you are really keen on the scan – I assure you I will get to it soon”
o  Get to the root of the demand

o  “Could I ask why you would like another CT scan?”
o  “Has anything in particular changed since the last scan?”
o  “Did someone go through the results of the last scan with you?
o  “Is there anything in particular that you hoped the scan would show?”

o  ICE
o  “Was there anything in particular that worries you about your headache?”
o  Be clear that you need to ask your questions if pushed

o  “I appreciate that you want the scan – unfortunately for me to make any decision or sign a scan form I
need to ask a few questions first…I hope that is ok?”
o  Buy time as you go along

o  “There may be better things than a scan for your symptoms – I just need to know a little more before we
can see what would help you best”

o  Don’t give answer too early
o  If you say ‘no’ – could get angry very early
o  If you say ‘yes’ – will be difficult when you change to ‘no’ later

o  Acknowledge fears
o  “I can see why you want another scan – headaches are not nice to put up with”
o  Be honest and frank in the second half

o  “I’m very sorry but I really don’t think another scan is going to benefit you in any way at present”
o  “There are certain side-effects of radiation and we need to make sure we do the best we can for your
health”"
“If there was any reason for a scan I would be the first to suggest it”
o  Offer alternatives
o  “I can see you are very keen – how about I discuss this with the radiologist for their opinion?”

Scenario 14
Mr Jonathan Griffiths
27 year old male

Mr Griffiths has been brought to A&E by his
brother who says that he ‘is not himself these
days’.

You are asked to carry out a psychiatric
assessment.

14. The Psychiatric History
o  Challenges
o Questions can be tricky to ask in a
sensitive way
o  Key end points

o Patient safety
o Non-judgemental history
o Support system in place
o  Buffer
o  “I would like to ask you a few questions about your thoughts and how you are feeling”
o  “Some may apply to you but some may seem a little strange – please bear with me”
o  Talk in 3rd party for challenging questions

o  “Have you ever heard voices in your head?”
o  “Sometimes when people feel like this, they can hear voices of people who are not around – is this ever the case?”
o  Suicidal risk
o  “Sometimes when people feel low like this, they often feel like life is not worth it, or sometimes like ending their life – is this ever
the case?”
o  Reassure symptoms are common

o  “These thoughts and symptoms are actually very common – you are certainly not alone in experiencing this”
o  “There is lots that can be done to help your symptoms”
o  Check insight
o  “Are you always aware that you are feeling like this / hearing these things / having these thoughts?”
o  “How do you feel about them?”

o  Habits/coping mechanisms
o  “Sometimes when people feel like this they can turn to things to help cope – smoking, alcohol, drugs perhaps. Can I check if
this is the case with yourself?”
o  Can you involve others?

o  “Sometimes people benefit from talking through their symptoms with someone who is a lot more
experienced with these than we are – how do you feel about this?”
o  If risk to self or others, need to be clear

o  “I’m actually a little worried by the things that you’ve been telling me. I would actually like you to see
another colleague of mine before you leave today”

Scenario 15
Mrs Stephanie Jones
43 year old female

You are asked to see Mrs Jones by the
nursing staff. She is currently an inpatient in
hospital and is being treated for a flare-up of
her Crohn’s disease.

She wishes to discuss something that
happened this morning.
15. Patient Complaint
o  Challenges
o  You didn’t see what happened
o  The patient doesn’t want to listen to
you
o  Don’t want to undermine colleague
but also want to respect the patient
o  Key end points

o  Patient’s frustration is managed
o  Ways to resolve the situation explored
o  Full options given to patient

o  Acknowledge their position
o  “I can see that you are frustrated”
o  “It seems like it was a challenging situation”
o  Apologise for their situation

o  “I’m sorry about that doctor”
o  “I’m sorry that you felt they were rude to you”
o  Don’t undermine colleagues or apply blame

o  “I can’t really comment on what happened as I wasn’t witness to
it”
o  Acknowledge their rights to complain

o  “You have every right to complain if you wish”
o  Offer to explain complaints procedure if they still wish to
o  Think about how to move the conversation forward

o  “Would it help if I…”
o  “How do you think I could help in resolving this for you?”

Scenario 16
Mrs Jenny Philips
38 year old female

Mrs. Philips presents with
problems with her periods. You
are asked by your consultant to
take a relevant history.

16. The Embarrassed Patient
o  Key end points
o Full clinical history despite
embarrassment
o Patient (or doctor) doesn’t feel too
uncomfortable
o  Challenges
o May take time to develop rapport
o We get embarrassed to ask certain
questions
o  Eye contact
o  Getting closer
o  Importance of time…
o  “There is no rush – please take your time”
o  Acknowledge the challenge and emotion

o  “I can see this is clearly difficult for you to talk about”
o  Thank them for coming

o  “Thank you for coming to the hospital to discuss this – I know
it can’t have been easy”
o  Reassure about common nature of problem

o  “What you are talking about is something that is very
common – you are certainly not alone”
o  Offer relevant alternatives

o  “If you prefer I could ask if a female doctor see you”
o  Remember about confidentiality

o  “If it makes it any easier remember that anything you say is
confidential unless safety issues for you or others arise”
Scenario 17
Mrs Kenny Adams
40 year old male

This gentleman has been admitted
with deranged liver function tests
(raised ALT and GGT).

His breath and clothes smell of
alcohol. Your consultant asks you to
discuss his alcohol habit.

17. Alcohol
o  Key end points
o Understand how much they drink
o Make aware of recommended limits
o  Challenges
o Patient may not believe they drink
too much
o Patient may become defensive
o  Ask openly
o  “How do you feel about your alcohol intake?”
o  “Are you aware of any guidance about alcohol?”
o  “Are you aware of some of the effects of excess alcohol on our body?”
o  Non-judgmental approach
o  “Drinking alcohol is a very common activity – we are not here to judge you – just guide on
its potential effect on health”
o  “Of course you make decisions about your lifestyle and habits – I think it is important that
we run through a possible harmful effects”
o  Clear advice
o  “Current guidance is to drink no more that 14 units of alcohol per week, men and women”
o  “You should also have 2-3 alcohol free days per week”
o  What is the reason for alcohol?

o  “Is there any particular reason that you do drink?”
o  Stress, boredom, habit, peer pressure
o  Are there any signs of dependence?

o  “What happens if you do not drink for a few days?”
o  Discuss cutting down clearly if needed

o  “Do you think you would be able to reduce your alcohol intake?”
o  “How can we best help you?”
o  “I think it is important that you consider reducing your alcohol”
o  “There are several health implications of drinking too much alcohol:….”
Copyright
Arora Medical Education Ltd Not to be used for medical advice
What we have covered

1.  Angry patient

2.  Breaking bad news
3.  Treatment refusal
4.  Counseling – diet advice
5.  Angry relative
6.  Domestic violence
7.  Sexual history taking
8.  Non-accidental injury
9.  The blaze patient
10.  Consent/capacity
11.  Palliative care / end-of-life issues
12.  Patients wants to leave hospital
13.  The demanding patient
14.  Psychiatric history
15.  Patient complaint
16.  Embarrassed patient
17.  Alcohol
Conclusions
ü  Acknowledge
ü  Emotion
ü  Body language
ü  Distance

Mindset matters
ü  You’ve seen enough
patients in your life!
ü  You know how to

talk to them!
ü  Being natural and

trusting instincts is
important!

Thank you! Don’t miss us on Social!
o  Facebook Group (over 11,000 members) – Dr Aman Arora

GROUP
o  live online teaching sessions
o  daily AKT video and image revision
o  Instagram (over 1500 followers) – @arorameded

o  YouTube (over 3500 subscribers) – Aman Arora

o  daily AKT short and long videos
o  SoundCloud (BRAND NEW!) – Dr Aman Arora

o  regular audio podcasts for communication
o  Twitter (over 1000 followers) – @aman999arora


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PLAB 2 Consultation Skills Course!

With Aspire Academy

Dr. Aman Arora

o Basic principles – what is key with consultation and communication?

o Regular breaks including lunch

o Relaxed but focused

o Informal – ask any questions

Dr. Aman Arora is an ex GMC PLAB 2 examiner.

ü You know how to

ü Being natural and

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o Good communication needs to be

o Key end points

o Regular reflection of anger

o Try not to make excuses/defend actions

o Acknowledge their importance

o Key end points

o Expect and allow for reaction

o Think support systems

o Don’t commit to answers if you don’t know

o Leave a method for ongoing communication afterwards

o Key end points

o Why are they refusing?

o Acknowledge their situation

o Clearly communicate ultimate risk

o Medication refusal in general

o Key end points

o Acknowledge potential barriers

o Explain risks clearly in relation to his MI

o Offer support – dietician/leaflets etc

o Key end points

o Empathise with their situation

o Explain ’Duty to every patient’

She has asked to speak with the doctor in the

o Key end points

o Be clear and consistent

o Ask about children

Your consultant asks you to carry out a sexual

o Key end points

o Signpost everything well

o Remember about confidentiality

o Key end points

o Honesty but clarity

o ‘Buffer’ social services / child safeguarding etc

o Predict “they’ll take my children away!”

o Encourage mum to be on your side if at all possible first

o If not however, need to be firm

o Key end points

o Back to basics – ICE

o Targeted second half to consultation

Your consultant has asked to assess his

o Key end points

o Key end points

o Giving time is paramount

o Don’t assume what their main concerns are

o Who else can be involved?

o Key end points

o What are the reasons for leaving hospital?

o Acknowledge their situation

o Do they understand ultimate risk?

o Key end points

o Get to the root of the demand

o Be clear that you need to ask your questions if pushed

o  Basic principles – what is key with consultation and communication?

o  Regular breaks including lunch

o  Relaxed but focused

o  Informal – ask any questions

ü  You know how to

ü  Being natural and

o  Good communication needs to be

o  Key end points

o  Regular reflection of anger

o  Try not to make excuses/defend actions

o  Acknowledge their importance

o  Key end points

o  Expect and allow for reaction

o  Think support systems

o  Don’t commit to answers if you don’t know

o  Leave a method for ongoing communication afterwards

o  Key end points

o  Why are they refusing?

o  Acknowledge their situation

o  Clearly communicate ultimate risk

o  Medication refusal in general

o  Key end points

o  Acknowledge potential barriers

o  Explain risks clearly in relation to his MI

o  Offer support – dietician/leaflets etc

o  Key end points

o  Empathise with their situation

o  Explain ’Duty to every patient’

o  Key end points

o  Be clear and consistent

o  Ask about children

o  Key end points

o  Signpost everything well

o  Remember about confidentiality

o  Key end points

o  Honesty but clarity

o  ‘Buffer’ social services / child safeguarding etc

o  Predict “they’ll take my children away!”

o  Encourage mum to be on your side if at all possible first

o  If not however, need to be firm

o  Key end points

o  Back to basics – ICE

o  Targeted second half to consultation

o  Key end points

o  Key end points

o  Giving time is paramount

o  Don’t assume what their main concerns are

o  Who else can be involved?

o  Key end points

o  What are the reasons for leaving hospital?

o  Acknowledge their situation

o  Do they understand ultimate risk?

o  Key end points

o  Get to the root of the demand

o  Be clear that you need to ask your questions if pushed

o  Buy time as you go along

o  Be honest and frank in the second half

o  Key end points

o  Talk in 3rd party for challenging questions

o  Reassure symptoms are common

o  Can you involve others?

o  If risk to self or others, need to be clear

o  Key end points

o  Apologise for their situation

o  Don’t undermine colleagues or apply blame

o  Acknowledge their rights to complain

o  Think about how to move the conversation forward

o  Acknowledge the challenge and emotion

o  Thank them for coming

o  Reassure about common nature of problem

o  Offer relevant alternatives

o  Remember about confidentiality

o  What is the reason for alcohol?

o  Are there any signs of dependence?

o  Discuss cutting down clearly if needed

1.  Angry patient

ü  You know how to

ü  Being natural and

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