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