Managing Difficult Conversations

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 • 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/ Givens The 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 SupportFind 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 DifficultStressfulConversations! • Debrief • Avoid being the one with the disease

Not All ConversationsWill 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 #1 Most 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 lie Don’t steal hope Be realistic

Someone Is Dying Listen ( Is the PATIENT speaking through an advanced directive?) Find your support/ Find their support Start the conversation Geography/ 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 Outcome Negative 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 Problem Society/ Legislature/ Peers now tell us We MUST have these conversations THIS is the pivotal time.

Drug & Alcohol ProblemsThe 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 Often PRC 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 Opinion Fatal Error Success comes through education first

Difference of Opinion With A Colleague Praise 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 Viewpoint The Golden Rule • Do unto others, as you would have others do unto you. • Those with the gold, make the rules. Every pathway has an economic angle.

Administration’s Viewpoint What brought you to the table? • What do they need from you? • What motivates you? Principles Priorities

Administration’s Viewpoint Great leaders get input from great 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

Managing Difficult Conversations