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Breaking Bad News: Part-2

Apr 19 | 3:30 PM

Practitioners frequently have to deliver bad news to their patients. This challenging endeavour necessitates patience and honed communication skills, as well as empathy for all people involved. We need to understand 3 things to do this effectively- 1. Your own emotions 2. Patient's mindset 3. The environment. These three things also form the crux of effective communication skills. As we discussed in the last chapter, there are a variety of patient-centered communication strategies we can use to accomplish this. In Chapter 2 of the series, we'll continue our discussion with Dr. Krishna Naineni about how to convey terrible news to patients successfully.

[Music] hello and good evening dear doctors thank you for joining us tonight on netflix i dr fatima on behalf of the entire team welcome you here on chapter 2 of breaking bad news as we've already previously established breaking bad news successfully and tactfully it's a very uh tough balance between being sensitive and being assertive and dr krishnani has beautifully guided us in the concept it will continue to do so in chapter 2 of the session so dr krishnani works as general practitioner in the southeast region of england he is a member of the royal college of general practitioners and a faculty at brighton in sussex medical school he is a passionate medical educator with an interest in listening center clinical communication he is serving as a chair for international listening associations healthcare team also co-founder of local academy which has been instrumental in delivering custom-made listening center clinical communication skills training program to healthcare professionals sir is also passionate about good food long distance walks and runs but yeah on a side note he also hates cooking thank you for joining us here tonight sir okay thank you father thank you for the introduction um i hope that all of you have received that email and you caught the printout with you because that's essential for today's session if not plan b would be we're going to upload the document nearer the time and you may wish to take a screenshot yes before we get started i would like to take this opportunity to thank midflix team for recognizing the value of clinical communication skills and providing the platform for speakers like me to come and share our perspectives people and my fans there is a fan so i need to make use of that we are in this together let's learn from each other and get better at clinical communication so listen to what i have to share carefully however if there is anything that you would like further clarification please reach out to us via netflix or you can email directly to me i'll share my email address at the end so we'll have a dialogue and we'll iron out the differences and move forward yeah i think there isn't anything that we can't solve with good communication you can solve everything everything i mean that everything okay let's get started so summary summary from last session uh those of you who haven't attended last session i hope that you have watched the recording anyway here is the summary so in the last session we talked about what is serious news we said patients prefer the word serious news to bad news and we also learned about what are the challenges of discussing serious news with patients and families and then we briefly introduced different framework module models for discussing serious news and then we realized that yes having frameworks gives us structure to base our consultations but having frameworks alone is not enough we need competence in three skill three competency must we need actually competence in three things to bring those framework models into action those three things are emotional intelligence listening intelligence and perception and then we learned and practiced how to check our perceptions how to manage our own emotions and how to express empathy so we have ended our session there that's the summary and we're going to practice some of the skills that we have learned in the first session now and i'm going to we are going to show good and bad examples of discussing serious news and i want you to reflect on them and share your reflections with us and together we're going to design a framework or a 10-step model that we are going to use from tomorrow in our clinical settings i hope you're ready for action so that's what we're going to i'm going to cover today as always you might have watched in the recordings and if you have been here before my only request is please please please please please listen with curiosity there is a lot of work that goes behind the scenes in bringing these sessions to you please don't dismiss anything that we say or do here there's a lot of research and evidence base and experience behind it please listen with curiosity ask questions okay the more you ask questions the more you get better at these abstract concepts take a mental picture of this image because you need it when you're watching the video shortly this is the breakdown of intentional presence when we say somebody is intentionally present what do we what do we mean by that it's because they're displaying all these characteristics they're the paraphrasing what the patients have said they are checking their assumptions they are reflecting their feelings asking the right questions at the right time in the right way as well as displaying effective non-verbal behaviors these are the examples in the video which you're going to watch shortly see how many of them the doctor is displaying or using or not what are the effects of using them effectively and not using them effectively i'm going to i'm not going to spend a lot of time on this slide this is to give you an idea that there are materials available for you to answer tough questions like how long do i have am i dying can you give me a rough estimate of what is the time that is available to me these are the graphs they help you to place your patient if the top the blue one is for cancer patients so when you get diagnosed they usually are healthy with minimal symptoms and then they deteriorate there will be a rapid decline depends where you are having the conversation with the patient so it helps you to answer those questions effectively we're going to have a session on this graph in particular with some case examples for you in the near future okay so i need two volunteers for this task could you please raise your hand eures are you up for it so bring on sanika okay and uh so sanika first [Music] and sub now yeah doctors you will receive a prompt on your screen please turn on your audio video sanika good evening hi sir how are you doing good evening where are you logging in from uh i'm currently at my house okay so which place are in which state it's um it's a city sony perth small city just near delhi capital of india fantastic so is this your first session or were you here before yeah i was not present in the first session but i'm very curious on this so yeah very good so let's get started then so this is your task sonia sanya isn't it sanika sanika this is your task sanika can you describe what you see go ahead fatima she has a minute describe what you see yes sir okay so we have the national flag of india we have the emblem in the center we have the national bird we have the national animal we have uh respected gandhiji and and there is a common man who is raising a cow and that's a farmer for sure that's all i see on the screen excellent sanika well done for participating in the task please listen to how this task evolves over the next couple of minutes is that okay and then if you want to come on stage you can always come back uh who was the next participant yes sir hello yeah hello good evening yeah good evening doctor okay can you turn on your video uh actually my mic is on i am not at a house actually okay that's don't do it not to worry not to worry thank you for coming on stage that's brilliant and thank you for participating in the task you have a minute your instructions like sanika or please describe what you see okay sanika said that there is showing the national flag of india an emblem showing there in the center and also national bird peacock is showing there and also in the left there is national anima that is lion and respected mahatma gandhi and [Music] one common man who [Music] is also there in this and also there is a respected uh jawala nehruji in the pic very good thank you um for participating in the task anything you want to add before you go [Music] actually i'm just observing that much no i i'll not add anything okay very good thank you um was it are you feeling a bit anxious in uh doing this task actually i just uh randomly uh got to get to know about your app and i don't know that even i can able to participate and also connect with you yes i'm feeling very good oh very good we find ways in making people engage okay very good so have a look at your comments you may want to correct couple of answers but this is not about what you know what you don't know definitely not but we are grateful that you have an order directly yeah i'm just thinking that uh the the pick off now i'm just looking at the comments when sanika also said that i just get confused that is it isn't it like wrong there and uh about the national animal also there's a tiger yeah it's tiger type yeah yeah i got it so people i mean this is not a general knowledge test okay so uh hold on to it i think um uh it's great in a way you helped me in making a point in emphasizing a point where emotions can come in our way and say things that you don't really mean i think it happens so fast we hold on to that thought later on now let's all of you people let's uh hi manisha thank you for joining let's listen to what fatima has to say so let's fatima are you ready for the task okay you got one minute sanika can you time fatima please okay you have a minute your task is please describe what you see okay so what i see is i see three colored strips primarily orange white and green and i see about uh one two three four five six images on them strewn across these strips so the first one let's talk about the orange strip that we see on top there are two images on it on the left side there is a what looks like an animal which is primarily orange with black stripes on the right side we see what seems to me like a bird and it is blue with green feathers on the white strip we have three images so on the left side there is a man who seems to be a senior citizen slightly older in the middle there is an image resembling a wheel and it is blue so on on the right side of the white strip itself i see a man a quite a serious looking man i could say enclosed in what i can as you are clothes of a freedom fighter and then we come on to the green strip your voice is breaking up yeah i think we lost her voice fatima we lost to your voice [Music] sanika can you hear me yes sir i can hear you okay uh fatima we lost you uh that's a minute uh thank you anyway you are nearer nearer to the end um so sanika what's the difference between the way you uh described and the way fatima described i think so she um described it from the very basic like whatever she's seeing right and i already had a perspective like okay this is this this is this and that's that's why i came across look okay this is a tiger i know this is the image in my mind that i've perceived and i will label it as a tiger but she saw it as something new something she would describe not just label it okay so you were labeling it you are communicating in conclusions and [Music] however she was only she knew it was tiger and peacock however she was describing it rather than saying it's a tiger yes sir you were able to label them and describe or talk communicate in conclusion because you are damn sure that it's a national animal uh national bird freedom fighters indian flag you're damn sure isn't it yeah yeah yes yes like many people it's okay when we are so sure we can communicate that way but how often in clinical practice that we are that confident that sure of the reason for patients emotions uh i think never exa can you say it loudly please never so which is the best way of communicating i think because we don't know what mindset the patient came in or he is in right now okay shall we wait and ask audience if they agree with us sanika or if they have a different view sure sir we can ask go on ask them okay everyone uh does everyone agree with me on that [Music] not always which is a fair point because sometimes with experience if you know the patient for years you might you all you might be confident of who that patient is what their context is what their stories because you've been seeing them for years then you may be confident about their emotions so yeah i think the absolutely right answer is uh not always but preferred method is be descriptive please what are the interpersonal relations with the person we are dealing with um if it's somebody's relative who's uh who's having the diagnosis the disease we're talking about it looks however my request for you [Music] assuming that many of the audience are junior clinicians or medical students or interns my request for you is whenever you are discussing serious news and sensitive news always i rarely use the word always but i'm using it now because i recognize the importance of it please check what you're seeing what you're hearing what you're feeling check your perception please it's one extra question but it saves you a lot of trouble going forwards and i would like to invite manisha asrani onto stage please we are spending some time here but that's very good we are spending some time because this is the most important point that you need to learn from today dr manisha would you turn on your audio video okay i need um whilst waiting for manesha i need couple more participants let's okay manisha is here one more please yes hi madisha okay yes good so whoever is on please turn on your audio and video okay hello can you listen me oh yes yes i can paish thank you for coming on stage are you ready to participate and give it a go yeah i'm sure i'm ready yeah very good where are you logging in from which place presently i'm in uh that's the place lovely place describe what you say one minute okay so i can see um a boy uh on the back of whom there is a cat there's a blacks like a structure something um which is resembling like a cat and this and another black structure on his right side which is resembling like a monkey and a word with some green leaves in his background and there are few insects on his head and there are some branches of the tree wrapped around his whole neck and that person is looking quite tensed and basically it's like a total nature figure how a person should live in the nature that's what can i say okay well done i'll wait for you why is that yes echo dr pierce could you just turn off your audio for a minute uh hold on yes so i i need i need one more participant please i think we need to really get this right i need one more participant uh okay so uh dr sharon deep could you come on stage please stay with us we this is all we are setting the scene so that we you really get most of uh this session and the sessions that are coming your way these are not only basics but very important learnings that you absolutely have to get them right okay that's why we are spending some time can anybody come on stage please hello sir okay go ahead you got a minute describe what you see so there is a lady or a man i can't make it out so there is in the center there is this lady mostly with black hair and facial expression like nothing and and on her left side there is a cat or a panther like animal on on the back side to the right there is a monkey black blackish and there are lots of leaves in the background with with the dried uh roots or stems like something stems uh in around the neck and around the shoulder with a black bird which is tied and the person is very serious and looking into something very sad yeah that's my thank you thank you for giving it a go people watch this recording again and see how much description he has done and how much how many assumptions he had made and um how many inferences and conclusions uh on labeling those people have done very important for you to appreciate this uh uh come on stage this is your task what questions you might ask ask you might ask me to know the meaning of what you're saying you can type in in the comments as well people what questions do you ask to know more about this this this image what questions would you ask if you're using the word feeling you're making an assumption you're concluding because you can't tell the emotions so what questions you might ask uh cyphula i would like to answer on stage oh why not yes i approved dr cyphula you can come on stage now is this person life very good point can you introduce yourself to me yes great question manisha keep them coming and also if you're not sure of any things that you see on the image what questions you might ask oh there's any crime committed by a person let's not go there no okay go ahead saifullah um sir hello good evening good evening and sir actually on the image what i am seeing is there is a person yeah i don't know whether it's a boy or girl but okay definitely her neck is strangled with something around like branches of tree or something okay whatever is behind the person he let it be [Music] okay you got it right very good what questions you might ask look at rajna's answer people she she is afraid of column animals and bird is helping human being to get rid of again i'm asking about what questions you would ask so i might ask why has she got that black bird which may be a hummingbird why has she got it on her neck uh what does the monkey represent what does the cat symbolize is she balancing good luck and bad luck because cat is seen as bad luck in some cultures and in in mexican cultures in folklore hummingbird is seen as good luck charm so is she balancing good luck and bad luck by those what do the butterflies represent um what do the dragonflies represent you know and yes like priests said uh it's not strangling there are thorn necklace around her neck and she is bleeding at places there's blood coming out what does it mean you know what does it mean okay so be curious and ask these questions those who want to know exactly what this image means please email us we'll send out the summary because the the the purpose of this session is not uh to learn about the meaning of um the the image the intention was if when we don't know this may be the patient who is displaying that emotion who may have got certain things that she might be carrying or he might be carrying to symbolize something so what questions shall we ask what questions should we ask to find out more about the story behind it okay i hope you all got the point fatima am i clear perfectly manisha do you have any more questions i know she was trying to come on stage okay very good so with yes just wanted to ask can we ask the question what brings you here in this position very good that's a great question build on it build on it you know what else would you ask you know what brings you more beyond that why is your expression okay so before that what is your uh impression of our expression you look sad you look worried why i wonder yeah yeah and go ahead oh that's what's like the first question i would ask yes can you see how how challenging it can be yeah so the more we look at these uh images and stories and learn more about ways of asking questions the easier it becomes when you are actually consulting with patient are you in any guilt are you in any guilt is a conclusion you already conclude that they are again who did this you already concluded that somebody did something to her this is a self-portrait so can you see the the the question questions are very challenging coming up with the right question can be challenging she might be hiding something which means that you're not believing the person what makes you so sad what makes you so sad okay so sad so you are doubly i don't know if there is a word you are very sure that she is sad you know okay anyway so we made our point which is be descriptive check your perceptions it's challenging to find out the real reason for the emotion however with right questions we can find out so clear your mind be open-minded don't let your emotions come in the way emotion is not the thing the meaning is in the person who is displaying that emotion the emotion has a story you need to find out the story you need to learn about that context don't let your judgments come between you and the person be aware of the judgment okay you can you be non-judgmental you can never be non-judgmental i'm going on record i'm saying it so loudly it's because if you somebody says to you i'm non-judgmental send them my way okay we'll have a dialogue we're all judging right now you're judging me oh he's making good points he's not making good points what the hell is he talking oh when is he going to talk about breaking bad news those are all judgments people those are all judgments okay good so if you have got the print out put the thumbs up please press that emoji what should be the ideal questions to ask rajna the next session or one of the next session is science and art of asking questions so great that you learned about importance of asking questions so we'll tell you what and how to ask questions later on okay we are building on layer by layer right so hold on fatima so fatima is going to play the video before that could you please upload that framework yes so serious newspaper feedback so if you have not got a printout could you please take a screenshot because without this it becomes challenging for you to reflect on the video fine does anybody got a printout please press the thumbs up emoji nobody oh yeah few oh many we will uh drop the links in the comment section as well many they've got many so play the video take a pen and paper and just scribble these few lines down [Music] see if the doctor is introducing to the patient c if he is explaining the purpose what's his body language like has he given any warning shot that serious news is coming what's the pace of the conversation easy giving information in small chunks is he using medical jargon or not is he asking questions allowing time for the patient to respond he is he responding empathetically and what kind of a follow-up has he arranged is it appropriate okay those are the roughly those are the statements that we want you to bear in mind when watching the video and most importantly pay attention to the time go ahead okay so i'm starting the video [Music] bye [Music] hi miss johnson good to see you again you too how you doing today um you know i uh we did the biopsy yesterday on your pancreas and we saw something funny there and uh the biopsy came back and it did show that there was a tumor now this is this is serious there's a tumor there but there are things that we can do about it um i'd like to set up an appointment for you to see a surgeon and probably also an oncologist do you mean do you think that this is cancer the tumor is cancer um yeah yeah tumor means this is cancer but there are many things that we can do for it a lot of experimental things going on um i'd like i'd like to see you to see one of the surgeons and also one of the oncologists and uh probably want to talk to you about some chemotherapy what the options are there those are kind of the main ways that we deal with this kind of a problem um do you have any questions oh i have a million questions but i don't even know where to start yeah that's you know that's that's real common um when this kind of thing happens um not surprising you know maybe a good idea if you saw one of our psychologists here um they can uh help you with that i don't know about that oh just a minute excuse me um got a got a message coming in listen why don't you think about things i'll set up the appointments for you to see the oncologist and surgeon think about whether or not you'd like to see a psychologist and give my office a call next week and i'll see you later i'll send my nurse in to make those appointments with you okay okay okay so i need people with who have got the printouts couple of them onto the screen please please raise your hand a couple come come on to the stage fast as you see the more you interact the more this will be uh effective for you and for others whoever watches this video later on okay yes in the pulsing well done and um okay yeah and doctor yeah can you please stand on your audio video okay good evening sir good evening where are you joining from sir i'm from belgium india very good so uh i'm assuming that you have the printout okay uh no sir sorry i joined late because of my clinic i just saw the video about the breaking the bad news the scenario what we face in india is totally different like what is shown in the videos my request comment on the video you saw please uh so actually like when we face the situation in clinics uh usually patients directly we won't be revealing it to the patient because uh usually they get scared so we have to reveal it to the relatives and many times relate to requesters not to tell these things to the patients so like how to do that that's my request please comment on the video if you have seen that's a separate question okay we're going to get there eventually but not yet okay i'm acutely aware that there are cultural elements that's not the discussion um do you have any comments on the video you saw no sir thank you anybody else thank you prasad so yes uh rajna would you like to be you can cross cheers yeah good evening i thought you were going to speak so okay uh according to me the uh doctor should be at least sitting it seemed very disrespectful keeping his leg up on the chair and i think he was not waiting enough for the patient to catch up he should have asked more questions whether she caught what the diagnosis was and if she had further questions and directly asking if she should be seeing a psychologist i think that should have been a measure for next visit or something talking about this should have been on the next visit so the first one should just focus on whether she understood and if she's comfortable with the information she got and yeah i think that's about it beautiful points they and are they difficult to do the points which you made right now are they easy to implement in clinical practice obviously those are difficult like these are the ideas you're sitting comfortably in a chair is it difficult okay oh no like if the patient is sitting then i think we should be on the eye level with the patient that's not difficult if she's startling then yeah yeah exactly right yeah that one and waiting five seconds for the patient to gather their thoughts is it difficult no it's not it's not asking a good question and being empathetic also none of them is difficult exactly okay exactly okay let's see what manisha has to say thank you sir so building upon what she said the first the checklist that you gave us includes introduction of self to the patient so the doctor came in a bit of hurry there was no formal introduction he did not introduce his name and what his role was and he rushed forward with the results that he had uh there was ex i mean he also did not explain the purpose he did not counsel her that i have your results and my purpose of the visit is to inform you what your results are uh he did not maintain good eye contact throughout only towards the end while he was leaving did he you know raise his head and see when while he was suggesting us appointment with us psychiatrist that was the only time i guess he just raised it other times he was just engrossed in his folder [Music] he did not provide a gentle warning to the patient about the bad news that he was going to take he did could not proceed did not proceed at the patient's face there was no 10 seconds 10 seconds of silence after breaking the news so uh and he rushed forward did not give the information in small chunks [Music] and he used the word tumor instead of cancer so that is he used medical jargon and he did not uh respond to the feeling of the patient she was visibly distressed when he said that there was a tumor first she couldn't understand when she made sense of that it's a cancer or it's a malignant growth he was visibly distressed he did not respond he i do not know if he offered realistic hope but he surely vaguely told about the various modalities of treatment or what they could go forward and there was a bit of lack of empathy because he was a bit pressed for time he had his uh keeper going off and then he had to move to the next patient so he seemed to be in a bit of a hurry and he arranged for follow-up but he did not do that personally he directed that to the nurse or the nurse practitioner okay so very good thank you for getting the printout manisha and giving us a detailed summary of the things that weren't good at the video that could have done better we have time for one more person [Music] thank you malaysia video dr kieran could you please come on stage go ahead karen hi hi doctor hi so um i wanted to comment on the video most of the points she has already covered but i want to tell you about my assessment so uh yeah so uh the very first thing was the introduction i don't have the checklist but whatever i assess so first was the introduction which was like the body language of the doctor and also it was not the complete introduction and secondly as the point has already been mentioned that the doctor should be sitting closer to the patient and maintaining eye contact and then uh although it was a private room uh but there was disturbance because the bus was on in between so there should not be any disturbance when you are discussing about the serious news and then the very important thing is this patient had abdominal pain and the investigation was done and she has come for the report so we need to first is we need to ask the open question like how she's feeling if she's having symptoms now or any fresh complaints and also because she has already gone through investigation so we need to know about the idea like the patient is aware of uh like what is going on or what the patient is thinking about the investigation result so that that shows us that is the patient had something in their mind whether the patient is prepared for the news or not so if the patient is not prepared we have to give warning shots so the warning shot is where we first ask the patient how they take the medical knowledge or the results how how will they take whether they want to know or they want anybody from the family with them so that is the basically i think that is the warning shot and if the patient is already had something in the mind that okay it could be some cancerous thing or something serious so that means that patient is some somewhere prepared to know the result so then after that we the doctor should break the news and very important it should be in chunks and we need to make sure that patient is understanding every statement we are making and uh then because this doctor he was giving too much information in a very short span which is actually uh the patient was not able to understand and in the beginning uh i forgot to mention that when he asked the patient the patient said i am feeling anxious so we need to make sure we need to know the reason why the patient is definitely about the investigation so and then uh there was no empathy and after breaking the bad news there should be a pause where the patient should imbibe all the uh information which has been given and we have to be very sympathetic and empathetic at that point and then um like we need to ask like if the patient has any concern after breaking the bad news so they they should ask us the person not the doctor who is giving all the information uh in a like single line uh uh i think uh those were the points very good you don't need a checklist you can write your own checklist what's your background uh i'm a pathologist your pathologist if a take this in a in a humorous way kiran okay um who said people you need um sessions and breaking brightness if you think sensibly logically emotionally from a patient's perspective you know what not to do when you know what not to do it's very easy don't do them everything else you do would be the right thing yeah thank you very much kieran for coming on stage and giving us that elaborative response very good every point you made is valid listen to these people all of you very carefully lack of time is relative what do i mean by that most of the times we rush through the patients because we are under impression or illusion of whatever that we don't have time we need to go through the patient okay system is busy fine however once in a while you come across a patient with whom you have to share the bad news or serious news now ask yourself who has got limited time you or the patient to whom you just said they have cancer they literally have limited time in their life all the the story which they've built and their the future is coming to an end so when we compare our lack of time with their lack of time we need to ask can i actually spend a couple more minutes here because i've just told her she's got cancer which they might perceive as dying they have limited time so invest those few extra minutes with those people please very important and as kiran said let them ask you the questions you answer them any comments so far okay if not be mindful of the time let's so the first video which was done not effectively was done in two minutes 31 seconds let's see the video which is done effectively and look at the time go ahead hi ms johnson how are you today yeah how did the biopsy go yesterday was it real painful i know it was it was okay it wasn't too bad okay um anybody here with you today or are you alone no i'm by myself okay um tell me what your understanding of why we did the biopsy yesterday well there they found something abnormal [Music] check it out and see what it was okay i've talked to the pathologist and i've gone over the slides with them and i'm afraid there's some bad news i'm afraid that you know i was concerned that this might be cancer and it was can you tell me a little bit about what's going through your mind is this a huge surprise we sort of discussed the possibility yesterday does this mean i'm gonna die well you know we saw the abnormality on your pancreas and it also looks like the cancer is in the liver as well um this is not a curable form of cancer with any treatments we have right now all i can think about is my parents they both died of cancer i just seem so hopeless yeah i i i hear you it may feel hopeless there are things that can be done there are treatments available that could potentially make you live longer would you like to talk about the treatment options now you feel like you're up to that i i think i need to wait just kind of think about what you just told me okay okay um would you like we can set up an appointment later today tomorrow morning perhaps you can bring someone is there somebody in your family who can come with you yeah i think i should have my children meet you and talk to you too okay maybe tomorrow okay we can set up a time tomorrow morning um what i'd like you to do and is maybe somebody who could be with you today even and talk about things and as this is going through your mind think about write down all the questions you have and we can discuss it tomorrow we talk about what the different options are i want to let you know that you know i'll be with you throughout this i've been your doctor for a while i'll be involved through whatever happens and we'll do this together i appreciate that okay see you tomorrow okay thank you uh for playing that video can one of you come on stage and reflect you what you witnessed is one of you dr pradeep as you might have seen let's say that's a good way in all aspects isn't it asking questions being empathetic body language and behavior i think the reason why we have shown you both examples is by making adjustments to the way we behave and ask questions we can conduct those consultations effectively and appropriately moving on unless there is someone who want to come on we want to move on is there anybody at home doctors okay sanika go ahead yeah sanika okay so during the video i saw um all from the checklist most of the points are covered like um he did not give an elaborate introduction maybe because he knew the patient already or the patient knew him already which was evident from the video then he um he tried to make her like he gave it time and then he said the bad news was coming and he asked the patient what is your perception of why the biopsy was done yesterday so uh he asked uh like that was a good point to address that he asked her then he was actually maintaining good eye contact throughout the conversation he was um he was mindful of what patient is understanding of whatever he's saying and then he was asking questions uh in between warming the patient he was empathetic throughout the conversation um he was giving her time to actually process what she what like he told about the diagnosis he did not use any medical jargons um he said it is a cancer and he he talked about before talking about the treatment modalities also he uh actually asked a question like how do you think um do you want to know about the modalities right now because the patient was overwhelmed with emotions it was clearly seen in the video that's most of the things that i could and he could he asked for a follow-up as well he was giving information in small chunks and whatever he uh whatever terms he mentioned uh were like understandable to the patient so yes that's that's good actually people i think it's very important for you to keep practicing these things and reflecting on all the conversations that you witness so the checklist that you have in your emails would give would break this is designed to break it down into different elements so that you know what your strengths are and what you need to improve and the strengths you already are good at keep doing them and the challenges you you learn and adapt and do it better can you upload the presentation the the the presentation and the session is done but please hold on five more minutes because i've got a few important slides to share with you those are very important for you okay so this one okay so people yeah we are extremely grateful for all of you for taking your time and investing energy in learning about these key skills fantastic keep attending and learn more you will of course you will get your certificates because we value your time and effort as well however again listen to this carefully please which is yes you have motivation that motivation has brought you here but the key question is how are you going to sustain your motivation for long term to learn these very important and sensitive skills the reason why i'm asking that question is that these are not assessed these are not part of your examination you're you're already busy with learning and doing other things so don't let it slide down the list please keep on practicing form study groups role play but here and request your seniors for more sessions tag along them for these conversations when you got some expertise you request your juniors to tag along with you to sustain motivation you don't need exams you don't need certificates you don't need assessment you need three things according to mr pink here he wrote a book in that he right he writes about three things autonomy which is you can be in charge you have the capacity to take charge of your own learning you know what is important what is not for you you can prioritize please prioritize this one mastery to become mastery in any skill it needs practice consistent practice it needs patience practice and perseverance so please please continue to learn purpose as i emphasized earlier on your purpose is beyond passing exams your purpose is beyond building your cv your purpose is beyond becoming a good communicator what's your purpose your purpose is to advance the medical field forward to provide high quality and safe patient care that's your ultimate purpose so be mindful of your overall purpose people as tamaleta mentioned earlier yes some of these skills can be imported into indian culture but some needs adaptation that's called individualization you need to take your cultural values your ethical frameworks into consideration and tweak and adapt some of these skills yes some families do not want the patient to know about the cancer diagnosis then you as a clinician should ask whose interest are you serving family or the patient what is the age of the patient has they got capacity has they got have they given you consent to share the information with the family so there's a lot of things that you need to take into consideration okay only then you can come up with an authentic clinical practice so see what you can use straight away see what needs adaptation before practicing look at this beautiful few lines a poem by samantha king holmes sometimes there are no words for the emotions you feel no way to describe it or get it out so you just sit there while a storm breaks havoc inside of you no one notices because if they could see it they would pay attention highlights the importance of being present with the patient and check the meaning behind the emotions which they are displaying and not displaying very important how can you develop and nurture your capacity to empathize with patient watch movies read books novels and ask these questions why do they do what they do the characters i mean how have their own experiences shaped their actions what would you do in their position so the more you get involved in the stories you read in the in the movies or the programs you watch and ask these questions you'll be able to appreciate the value of emotional competence fatima would you mind reading it we are surrounded by sound it's easy to become distracted by the daily noise it is important that you take the time to focus and listen to your inner voice that much power should never be ignored you have the power you have the capacity people you can do anything you can please please please invest time and energy in learning these key skills okay attend these sessions you might come to the sessions wanting to learn everything about the said topic however it cannot be learned in one hour we are carefully building these sessions layer by layer there are record recordings available watch it in sequential order each session is taking you close to becoming a competent clinical communicator however attending these sessions alone is not important you need to put in work you need to practice with your colleagues and patients and reflect on them so this is where you can find us on instagram there are useful posts and material and we've got some e-learning modules as well good that's the end of the sessions so as with all sessions thank you fatima thank you netflix anybody want to come on stage finally and share your appreciation or comments and we do have a lot of attitude comments in the comment section anybody who yes we have a raised hand request from if you have time yeah yeah sir right now i'm in usa but it was appealed by your talk and really it was very very in fact we learned so many things and we know how much we ignore the patience part of the feelings and the perceptions and i'm sure we are going to be better clinician if you keep attending success and so it was really wonderful and eye opener and many many learning points as you rightly said it cannot be learnt in one session we have to keep revising and put it into practice i really like this essence and i really enjoyed that what you said that we have to keep reading and watching the books also in the same perceptions it's just three for the sake of looking at it but we should learn from that and we should try to have a role playing for a safe yeah thank you very much it was really an excellent very good thank you thank you so much thanks thanks thank you dr so one more one more person please yes the session was incredibly enlightening sir and we're all going to introspect tonight and ask a few basic existential questions very important anybody who wants to come on stage is sonic on stage too we do have someone here yes i was just trying to thank you for your lovely session i think i'm looking forward to having more sessions with you i'm really motivated today so thank you so much to sustain your motivation no yes i think i will yes okay thank you for for your participation although it was your first session yes thanks to sanika so the team um the backstage team thank you bye-bye netflix bye-bye thank you for your time you

BEING ATTENDED BY

Dr. Naved Khan & 1799 others

SPEAKERS

dr. Krishna Naineni

Dr. Krishna Naineni

Director & Co-Founder of Glocal Academy | Member of International Listening Association (ILA) | Member of Royal College of General Practitioners since 2011 and a training faculty at The Brighton and S...

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dr. Krishna Naineni

Dr. Krishna Naineni

Director & Co-Founder of Glocal Academy | Mem...

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