1 Difficult Medical Consultation Restoration plus Our Strength Dr. Ares Leung Deputy Medical Director Union Hospital 2012.

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Difficult Medical ConsultationRestoration plus Our Strength

Dr. Ares Leung

Deputy Medical Director

Union Hospital

2012

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Why are clients “difficult”?

Management of Difficult Medical Consultation

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Management of Difficult Medical Consultation

Stress from disease, anxiety: illogical response stimulated

Loss (potentially major, real, future, imagined): Grief response

Ignorance / Lacking knowledge (education focus of doctors needed)

Mismatched Expectation: hope for cure / perfection (cost – financial, material, convenience, big ego, etc) mismatch and high; unexpected interaction (e.g., ‘wrong’ gender of doctor)

Lack of social & communication skill (‘family education’, society tendency to challenge and say no, failure to recognize that the social approach causes problems, long-windedness)

Deliberate: see how the doctor respond, personal gain, inappropriate intentions (one extreme: seducing)

Reasons for clients to be difficult

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Model of a muscular doctor: The rationale

We are doctors who are brave intellects

Patient statusFriendsAllies of self

We do not bend our back in relation to extrinsic factors…

…nor change our care due to intrinsic factors

Convenience

Material gain Financial return

Self-InterestFACE

Value

CompetenceExperience

Pressure

Request

Begging

5Building your strengths is crucial

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Management of Difficult Medical Consultation

Power to

educate

Support from

colleagues

Home match

The Rationales

智者不惑勇者不懼 仁者無敵

Strength: Model of a muscular doctor

We are stronger at home

Use the powerthat society allows us to teach & change

We gain strengthThro’ mutual support

Core Fitness

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Model of a muscular doctor: The rationales

Power to educate

Support from

colleagues

Home match

The Rationales智者不惑勇者不懼仁者無敵

Core Fitness

• Fundamental duty of doctor

• not to decide or intervene but to find out, analyze, explain and educate on the truth, all the truth and nothing but the truth

• I am only a doctor but I am still a doctor

• A leader but not a dictator

The rationales hold the fundamental duty of a doctor

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Restoration to Home Match

Restoration: The best way to handle a difficult consultation is to change it into a normal familiar one.

Analogy with difficult surgery: Most important work at startThe best solution is to restore normal anatomy

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Home match

Power to educate

Support from

colleagues

Home match

The Rationales智者不惑勇者不懼仁者無敵

Restoration: key to a normal consultation

We are stronger at home

Change the settings back to a familiar usual consultation.

When presented with Bewildering information (excessive, e.g., patients studying over the web, health care professionals), return to our own pace and solve problems at our choice of method

Go by methods of the client if it is still comfortable to doctor, but change if not comfortable

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The concept of home match

Preservation of important elements with regular consultations.

Stay positive in our tone, posture, active listening Express confidence Show empathy and sympathy: reflection of understanding

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Use negotiation and communication techniques to overcome dead-locks

4 Identify areas of difference Prioritize issues of discussion Watch out for non-verbal clues Connect behaviors to feelings

Control to the long winded.

2 Explicit acknowledgement to facts, relations and feelings Use body language to stop repetition or to encourage dialogue Ask Questions & give instructions to direct flow, but with care

Process techniques to control flow without use of power

3 Deal with emotion, control overreaction Maintain appropriate direct dialogue Search for common interest

Home match

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Model of a muscular doctor in a Home match

Communication techniques Some useful dialogues

Identify areas of difference “ it seems your priorities are…”

Prioritizing issues of discussion “what is the most important part of this problem…”

“should we first focus on…, and then we shall come back to other problems”

Focusing “wait a minute, we seem to be losing what we are talking about”

Non-verbal clues “you seem not interested in this solution, (you are a bit quiet here)..”

Connecting behaviour to feelings

“whenever we talk about this, you seem worried in the face, restless…”

Practice service dialogue to sharpen your communication

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Model of a muscular doctor in a Home match

Know the Do’s and Don’ts of a normal consultation

Do’s

Stay positive in communication Engage client and accompanying

people in communication Explain on basis of facts, evidence Empathy: not an act, but a true

concern List solutions, explain pros and cons, Let the patient decide

Don’ts

React Argue Reject Push Escalate (conflict and emotion) Just pronounce for creditability Speculate (tell only confident,

honest and factual answers) Yield to inappropriate demands:

use ‘no’ sensibly

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Model of a muscular doctor: Power to educate

Power to

educate

Support from

colleagues

Home match

The Rationales智者不惑勇者不懼仁者無敵

Educate to achieve mutual satisfaction, not victory

UUse the power that society allows us to teach & change

MManage expectations Explain in full Context in best interest of patient

Technical intervention is only part of care

Do not overstate the success of intervention

Charges do not go too high

IInvolve patient (and families) in decision making

AArrange objective provision of independent second, third or even forth opinion if needed.

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Model of a muscular doctor: Support from colleagues

Power to educate

Support from

colleagues

Home match

The Rationales智者不惑勇者不懼仁者無敵

Engage colleagues, same specialty and/or other specialty

We gain strength thro’ mutual support

Refer to friends for independent second opinion

At time of complaint: always engage independent third party

Refer to public service when in need and no urgency for immediate care.

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Handling disagreement

What if disagreement persists despite continuous effort?

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Handling disagreement

Learn to say a good “NO”

Usual approach:

I think what you are wrong - Direct confrontation

I have power not to go according to your request

“There are only these people who would try to please you, and I am not that fortunate to be so privileged. They are: your parents, your spouse, your children; NOT ME”

“The society has not granted me this power to do what you demanded from me, sorry.”

“I shall never cheat you, so I cannot cheat anyone else (but be careful with words such as cheating).”

“I tell this 唔啱聽 to you, but it is all for your own good.”

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Our duties: tell all information

including the not-so-good outcome

try the best to avoid adversity, but we cannot guarantee it

Patient need to balance between the goal of the intervention versus risks, not just to concentrate on risks

We need to tell patients:

1) “every doctor has complications, and “I myself” is no exception (image of objectiveness). Better doctors have a lower complication rate, but still see complications when they do enough.”

2) Then systematically and logically explain chance of adversity

Consent without fears

Handling disagreement

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Terminate the doctor patient relationship tactfully

Handling disagreement

Frank description/ communication

Explain the decision (best interest of pt.)

Make sure no immediate health risk

Offer a fair referral letter to public service

Give as much info (accompany pt if possible)

Reassure pt that he can return in future

Be polite, professional. Keep our smile.

Bid farewell and ask nurse to escort pt. out

Keep a good record (why termination)

Maintain expression of regret (sorry)

*Do not threaten patient with high fees

NNote:

DDecline to specific treatment does not necessarily lead to termination of relationship.

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Handling disagreement

Mutual disagreement is not a challenge if we know how to deal with it.

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Key Learning

Power to educate

Support from

colleagues

Home match

The Rationales智者不惑勇者不懼 仁者無敵

Do get yourself familiar with the model of a muscular doctor

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Thank you !

Dr. Ares Leung

Deputy Medical Director

Union Hospital