Www.pspbc.ca Communicating With Chronic Pain Patients Drs. Wesley Buch & David Hunt.

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Communicating With Chronic Pain Patients

Drs. Wesley Buch & David Hunt

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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?

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Scenario 1

What’s wrong here

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Scenario 1: The Wound Up - Gobbledygook Physician

What would you do differently?

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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

What do we suggest?

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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

What do we suggest?

The Wound Up - Gobbledygook Physician

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Scenario 2

What’s wrong here

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Scenario 2: The Frustrated – Stuck Physician

What would you do differently?

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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

What do we suggest?

The Frustrated - Stuck Physician

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“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)

Empathic script for frustrated physician

The Frustrated - Stuck Physician

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Scenario 3

What’s wrong here

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Scenario 3: The Argumentative Patient

What would you do differently?

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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

What do we suggest?

The Argumentative Patient

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“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.”

Script for argumentative patient

The Argumentative Patient

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Scenario 4

What’s wrong here

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Scenario 4: The Rescuing – Discouraged Physician

What would you do differently?

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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.

What do we suggest for the Rescuing Physician?

The Rescuing – Discouraged Physician

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“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.”

Script for Rescuing Physician

The Rescuing – Discouraged Physician

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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

What do we suggest for discouraged physician?

The Rescuing - Discouraged Physician

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“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.”

Script for Discouraged Physician

The Rescuing - Discouraged Physician

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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.

Where to learn more

Doctor – Patient Communication

www.pspbc.ca

For more information

Practice Support Program

115 - 1665 West Broadway

Vancouver, BC V6J 5A4

Tel: 604 736-5551

www.pspbc.ca