Communicating With Chronic Pain Patients

1. Communicating With Chronic Pain Patients Drs. Wesley Buch & David Hunt Sheraton Wall Centre Vancouver December 05, 2013

2. Format • Interactive Format • Four Scenarios • Three Repeating Questions • What’s Wrong Here? • Patient Feels? • Physician Feels? • What Would You Do Differently? • What Do We Suggest?

3. What’s wrong here Scenario 1

4. What would you do differently? Scenario 1: The Wound Up - Gobbledygook Physician

5. What do we suggest? • Prepare yourself for patient in minute before entering office • “wind up” is contagious • “wind down” starts with physician • Look at the patient. • Talk slowly. Move slowly. • Focus on one or two major problems • make arrangements to see again for other problems. The Wound Up - Gobbledygook Physician

6. What do we suggest? • Speak slowly in ordinary language at patient’s level of understanding • Teach back technique (patient) • Invite a family member or friend to attend • Refer to Patient Self-Management & Health Literacy Module The Wound Up - Gobbledygook Physician

7. What’s wrong here Scenario 2

8. What would you do differently? Scenario 2: The Frustrated – Stuck Physician

9. What do we suggest? • Look for cues in yourself of feeling angry • Check & drop your biases at door • Deliberately choose an empathic approach • Consult – you’re not alone. • Sample script The Frustrated - Stuck Physician

10. Empathic script for frustrated physician • “I can see you’re still in a lot of pain. That must be so frustrating for you. It’s frustrating for me too & I don’t have your pain. I think we’re both feeling stuck.” (joining) • “Trying new strategies takes time and small steps. As I’ve explained, when you engage in paced activity you will strengthen your body so that you can do more than you’re doing now without pain flare-ups.” • “You might already know what to do but you worry about moving more because of pain or even re-injury.” (fears, catastrophizing) • “So let’s look at what part of our plan isn’t working yet.” (problem-solving) The Frustrated - Stuck Physician

11. What’s wrong here Scenario 3

12. What would you do differently? Scenario 3: The Argumentative Patient

13. What do we suggest? • Do not personalize or become defensive. • Is your manner or approach off-putting? • Set boundaries & limits. Time to let go? • Do you wonder about unspoken agendas? • Sample script The Argumentative Patient

14. Script for argumentative patient • “You still have pain.” • “My treatment suggestions do not appear to be working for you.” • “You seem more interested in trying these other therapies.” • “You can always return.” The Argumentative Patient

15. What’s wrong here Scenario 4

16. What would you do differently? Scenario 4: The Rescuing – Discouraged Physician

17. What do we suggest for the Rescuing Physician? • What cues your urge to rescue? • Self-coaching: “What does this patient really need or want?” “Will I really help this patient by giving another round of Oxys?” • Script that is empathic & firm. The Rescuing – Discouraged Physician

18. Script for Rescuing Physician • “The research & my experience with this medication tells me that higher levels of these Oxys are bad for patients. This is because they lead to complications that are harmful.” • “For example, you start to notice that you have to take increased doses just to get the same effect. But soon you get less relief and then more pain.” • “If these medications allow you to move more, it makes sense to use them. Otherwise, we need to find a different plan.” The Rescuing – Discouraged Physician

19. What do we suggest for discouraged physician? • Are you aware of feeling discouraged about this patient? • Self-coaching: “I’m feeling discouraged about this patient. How can I proceed in a more hopeful manner?” • Sample script The Rescuing - Discouraged Physician

20. Script for Discouraged Physician • “Although there’s no specific diagnosis, I do believe that you have real pain.” • “All the consults and tests support your experience of chronic pain. And there are some good ways to manage that pain.” • “The best pain management will come from us working together to find the right combination of pain self-management and other treatments to support you in this.” • “For example, I doubt that you will harm yourself if you do more around the house in a paced way. And this will help you both mentally & physically to prepare for work.” The Rescuing - Discouraged Physician

21. Where to learn more • F. Daniel Duffy et al (2004), “Assessing competence in communication and interpersonal skills,” Academic Medicine, 79(6), 495-507. • Patricia L.B. Lockyear, Dec. 9, 2004, “Physician-patient communication: enhancing skills to improve patient satisfaction.” www.medscape.com • Peter Tate (2010), The Doctor’s Communication Handbook, 6th Ed. Abingdon Oxon, Radcliffe Publishers. • L. Wen & J. Kosowsky (2012), When doctors don’t listen. NY: St. Martin’s Press. Doctor – Patient Communication

22. For more information Practice Support Program 115 - 1665 West Broadway Vancouver, BC V6J 5A4 Tel: 604 736-5551 www.pspbc.ca